title: Intestinal Necrosis Associated with Orally Administered Calcium Polystyrene Sulfonate Without Sorbitol.
abstract: OBJECTIVE
  To describe a case of extensive intestinal necrosis with oral intake of calcium polystyrene sulfonate without sorbitol.
  
  
  METHODS
  A 73-year-old woman was admitted to the emergency department with abdominal pain. Abdominal computed tomography (CT) scan showed widespread dilatation of the bowel. The diagnosis of acute colonic pseudoobstruction was made. On day 3, her serum potassium level rose to 5.6 mEq/L. It was treated with hydrocortisone 100 mg/day and calcium polystyrene sulfonate 15 g/day via nasogastric tube from day 3 to day 6. On day 6, the severe abdominal pain recurred, with abdominal tenderness. CT scan showed pneumoperitoneum and peritoneal effusion. At surgery, 2 lenticular jejunal perforations and an ischemic cecum were found. Microscopic findings indicated that the transmural abscess contained massive inflammatory infiltrate and the cecal mucosa showed ulceration and inflammation with a fibrinous and purulent coating. Small gray-purple or blue angulated crystals were embedded in the cecal and most of the jejunal mucosal ulcers. On day 19, the patient died of multiple organ failure after her third laparotomy.
  
  
  CONCLUSIONS
  Ion-exchanging resins are given orally or by retention enema for the treatment of hyperkalemia. The most commonly used and best-established resin is sodium polystyrene sulfonate. However, it is known to promote colonic necrosis when sorbitol is also given or especially in patients with renal failure or postoperative ileus. Calcium polystyrene sulfonate is another ion-exchange resin. There are few reports of adverse effects in the literature. Our case is interesting for 2 reasons: the resin given was calcium polystyrene sulfonate and sorbitol was not used.
  
  
  CONCLUSIONS
  Like sodium polystyrene sulfonate, calcium polystyrene sulfonate is an ion-exchanging resin that can promote bowel necrosis. We believe that it should not be used with sorbitol or when bowel transit time is slowed.
authors.affiliation: Philippe Goutorbe MD, Clinical Specialist, Head of Department of Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France goutorbephil@live.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Goutorbe
authors.affiliation: Ambroise Montcriol MD, Clinical Specialist, ICU, Sainte Anne Military Teaching Hospital.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Montcriol
authors.affiliation: Guillaume Lacroix MD, Clinical Specialist, ICU, Sainte Anne Military Teaching Hospital.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lacroix
authors.affiliation: Julien Bordes MD, Clinical Specialist, ICU, Sainte Anne Military Teaching Hospital.
authors.forename: Julien
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Eric Meaudre MD, Clinical Specialist, ICU, Sainte Anne Military Teaching Hospital.
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
authors.affiliation: Jean-Baptiste Souraud MD, Clinical Specialist, Anathomopathology, Sainte Anne Military Teaching Hospital.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Souraud
mesh_terms: D000368:Aged; D002432:Cecum / Q000098:blood supply / Q000473:pathology; D003112:Colonic Pseudo-Obstruction / Q000150:complications / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000188:drug therapy; D007413:Intestinal Mucosa / Q000473:pathology; D007416:Intestinal Perforation / Q000139:chemically induced; D007441:Intubation, Gastrointestinal; D007511:Ischemia / Q000139:chemically induced; D007583:Jejunum / Q000473:pathology; D009336:Necrosis / Q000139:chemically induced; D011137:Polystyrenes / Q000009:adverse effects*; D013012:Sorbitol
chemical_list: D011137:Polystyrenes; D013012:Sorbitol; C003321:polystyrene sulfonic acid