title: Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review.
abstract: BACKGROUND
  Sodium polystyrene sulfonate (Kayexalate; Sanofi-Aventis, Paris, France) is a cation-exchange resin routinely used in the management of hyperkalemia. However, its use has been associated with colonic necrosis and other fatal gastrointestinal adverse events. Although the addition of sorbitol to sodium polystyrene sulfonate preparations was previously believed to be the cause of gastrointestinal injury, recent reports have suggested that sodium polystyrene sulfonate itself may be toxic. Our objective was to systematically review case reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use.
  
  
  METHODS
  MEDLINE (1948 to July 2011), EMBASE (1980 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (1993 to July 27, 2011), bibliographies of identified articles, and websites of relevant drug agencies and professional associations in the United States and Canada were reviewed to identify eligible reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use. Causality criteria of the World Health Organization causality assessment system were applied to each report.
  
  
  RESULTS
  Thirty reports describing 58 cases (41 preparations containing sorbitol and 17 preparations without sorbitol) of adverse events were identified. The colon was the most common site of injury (n=44; 76%), and transmural necrosis (n=36; 62%) was the most common histopathologic lesion reported. Mortality was reported in 33% of these cases due to gastrointestinal injury.
  
  
  CONCLUSIONS
  Sodium polystyrene sulfonate use, both with and without sorbitol, may be associated with fatal gastrointestinal injury. Physicians must be cognizant of the risk of these adverse events when prescribing this therapy for the management of hyperkalemia.
authors: Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada. harelz@smh.ca
authors: Ziv
authors: Z
authors: Harel
authors: Shai
authors: S
authors: Harel
authors: Prakesh S
authors: PS
authors: Shah
authors: Ron
authors: R
authors: Wald
authors: Jeffrey
authors: J
authors: Perl
authors: Chaim M
authors: CM
authors: Bell
mesh_terms: D002411:Cation Exchange Resins / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D003108:Colonic Diseases / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced; D011137:Polystyrenes / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D013012:Sorbitol / Q000008:administration & dosage / Q000009:adverse effects / Q000633:toxicity
chemical_list: D002411:Cation Exchange Resins; D011137:Polystyrenes; D013012:Sorbitol; C003321:polystyrene sulfonic acid