title: Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study.
abstract: BACKGROUND
  Hyperkalemia is a common problem in hospitalized patients, especially those with underlying chronic kidney disease, but evidence-based guidelines for its treatment are lacking. Sodium polystyrene sulfonate (SPS), a cation exchange resin first approved by the FDA for the treatment of hyperkalemia in 1958, is frequently used alone or in conjunction with other medical therapies to lower serum potassium. Recently, the safety and efficacy of SPS have come into question based on multiple reported cases of bowel necrosis associated with SPS administration.
  
  
  OBJECTIVE
  The primary objective of this study was to evaluate the use of SPS for the treatment of hyperkalemia, at a large tertiary community teaching hospital, to determine its effectiveness and the incidence of related adverse side effects.
  
  
  METHODS
  A retrospective chart review was performed on all adult inpatients receiving single-dose SPS at a 466-bed tertiary community teaching hospital over a 3-year period.
  
  
  RESULTS
  501 patients received SPS for the treatment of hyperkalemia during their index hospital stay. Serum potassium levels decreased by 0.93 mEq/L on average at first recheck after SPS administration, with or without additional medical treatments. Our study identified 10 cases of hypernatremia (greater than 145 mEq/L), 31 cases of hypokalemia (less than 3.5 mEq/L), and 2 cases of bowel necrosis related to the administration of SPS.
  
  
  CONCLUSIONS
  Our results suggest a serum potassium reduction of less than 1 mEq/L after administration of SPS for the treatment of acute hyperkalemia. Additionally, this study offers some evidence that the use of SPS may be associated with harm. We further note the need for standardized guidelines for the treatment of hyperkalemia at our institution.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Hagan
authors.forename: Crystal A
authors.initials: CA
authors.lastname: Farrington
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Wall
authors.forename: Mark M
authors.initials: MM
authors.lastname: Belz
mesh_terms: D000208:Acute Disease; D000368:Aged; D002411:Cation Exchange Resins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006955:Hypernatremia / Q000139:chemically induced; D007008:Hypokalemia / Q000139:chemically induced; D007422:Intestines / Q000473:pathology*; D008297:Male; D009336:Necrosis / Q000139:chemically induced; D011137:Polystyrenes / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012189:Retrospective Studies
chemical_list: D002411:Cation Exchange Resins; D011137:Polystyrenes; C003321:polystyrene sulfonic acid; D011188:Potassium