title: Evaluation of Sodium Polystyrene Sulfonate Dosing Strategies in the Inpatient Management of Hyperkalemia.
abstract: Hyperkalemia occurs frequently in an inpatient setting, for which sodium polystyrene sulfonate (SPS) is a common treatment modality. Few studies have investigated the dose-response of SPS.
  
  
  
  To quantify the change in serum potassium after 15-, 30-, and 60-g oral and 30-g rectal doses of SPS. Secondary objectives were to compare the proportion of patients attaining post-SPS dose normokalemia between dosing groups and to investigate the effect of certain characteristics on SPS dose-response.
  
  
  
  The reduction in serum potassium after 15-, 30-, and 60-g oral and 30-g rectal doses of SPS administered to adult inpatients was evaluated through a retrospective chart review. Ottawa Hospital Research Ethics Board approval was obtained prior to data collection.
  
  
  
  A total of 118 patients were included in the analysis. Serum potassium levels were reduced by 0.39, 0.69, 0.91, and 0.22 mEq/L following 15-, 30-, and 60-g oral doses and a 30-g rectal dose of SPS, respectively. A greater proportion of patients (50% vs 23%) remained hyperkalemic in the 15-g versus the 60-g group (P = 0.018), and all patients in the rectal group remained hyperkalemic. No patient in any group experienced postdose hypokalemia. The influence of all studied interindividual characteristics on SPS dose-response was clinically nonsignificant.
  
  
  
  Mild hyperkalemia can be effectively treated with a single 60-g oral dose of SPS as monotherapy, with minimal risk of hypokalemia. Moderate to severe hyperkalemic episodes warrant alternative therapy. The potassium-lowering effect is correlated to SPS dose and is independent of interindividual characteristics.
authors.affiliation: Kingston General Hospital, ON, Canada University of Toronto, ON, Canada mielen.mistry@mail.utoronto.ca.
authors.forename: Mielen
authors.initials: M
authors.lastname: Mistry
authors.affiliation: The Ottawa Hospital, ON, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Shea
authors.affiliation: The Ottawa Hospital, ON, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Giguère
authors.affiliation: The Ottawa Hospital, ON, Canada.
authors.forename: My-Linh
authors.initials: ML
authors.lastname: Nguyen
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000328:Adult; D002614:Chelating Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy*; D007008:Hypokalemia / Q000139:chemically induced; D007297:Inpatients; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011137:Polystyrenes / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D002614:Chelating Agents; D011137:Polystyrenes; C003321:polystyrene sulfonic acid; D011188:Potassium
keywords: Kayexalate; dose-response; hyperkalemia; sodium polystyrene sulfonate