Sodium Polystyrene SulfonateU.S. Brand Names: Kayexalate�(r); Kionex™; SPS�(r)
Generic Available: Yes
Canadian Brand Names: Kayexalate�(r); PMS-Sodium Polystyrene Sulfonate
Use: Treatment of hyperkalemia
Pregnancy Risk Factor: C
Lactation: Excretion in breast milk unknown/use caution
Contraindications: Hypersensitivity to sodium polystyrene sulfonate or any component of the formulation; hypernatremia, hypokalemia, obstructive bowel disease
Warnings/Precautions: Use with caution in patients with severe CHF, hypertension, edema, or renal failure; avoid using the commercially available liquid product in neonates due to the preservative content; large oral doses may cause fecal impaction (especially in elderly); enema will reduce the serum potassium faster than oral administration, but the oral route will result in a greater reduction over several hours.
Adverse Reactions: Frequency not defined. Endocrine & metabolic: Hypernatremia, hypokalemia, hypocalcemia, hypomagnesemia Gastrointestinal: Anorexia, colonic necrosis (rare), constipation, fecal impaction, intestinal obstruction (due to concretions in association with aluminum hydroxide), nausea, vomiting
Overdosage/Toxicology: Symptoms of overdose include hypokalemia including cardiac dysrhythmias, confusion, irritability, ECG changes, muscle weakness, and GI effects. Treatment is supportive, limited to management of fluid and electrolytes.
Drug Interactions: Systemic alkalosis and seizure has occurred after cation-exchange resins were administered with nonabsorbable cation-donating antacids and laxatives (eg, magnesium hydroxide, aluminum carbonate). Digitalis toxicity may occur with hypokalemia.
Stability: Store prepared suspensions at 15°C to 30°C (59°F to 86°F); store repackaged product in refrigerator and use within 14 days; freshly prepared suspensions should be used within 24 hours; do not heat resin suspension
Mechanism of Action: Removes potassium by exchanging sodium ions for potassium ions in the intestine before the resin is passed from the body
Pharmacodynamics/Kinetics: Onset of action: 2-24 hours Absorption: None Excretion: Completely feces (primarily as potassium polystyrene sulfonate)
Dosage: Children: Oral: 1 g/kg/dose every 6 hours Rectal: 1 g/kg/dose every 2-6 hours (In small children and infants, employ lower doses by using the practical exchange ratio of 1 mEq K+/g of resin as the basis for calculation) Adults: Hyperkalemia: Oral: 15 g (60 mL) 1-4 times/day Rectal: 30-50 g every 6 hours
Administration: Oral: Administer oral (or NG) as ~25% sorbitol solution; never mix in orange juice. Chilling the oral mixture will increase palatability. Rectal: Enema route is less effective than oral administration. Administer cleansing enema first. Retain enema in colon for at least 30-60 minutes and for several hours, if possible. Enema should be followed by irrigation with normal saline to prevent necrosis.
Monitoring Parameters: Exchange capacity is 1 mEq/g in vivo, and in vitro capacity is 3.1 mEq/g, therefore, a wide range of exchange capacity exists such that close monitoring of serum electrolytes (potassium, sodium, calcium, magnesium) is necessary; ECG
Reference Range: Serum potassium: Adults: 3.5-5.2 mEq/L
Dietary Considerations: Do not mix in orange juice. Sodium content of 1 g: 31 mg (1.3 mEq).
Patient Education: Emergency instructions depend on patient's condition. You will be monitored for effects of this medication and frequent blood tests may be necessary. Oral: Take as directed. Mix well with a full glass of liquid (not orange juice). You may experience nausea or vomiting (small, frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or constipation or fecal impaction (increased dietary fluids and exercise may help). Report persistent constipation or GI distress; chest pain or rapid heartbeat; or mental confusion or muscle weakness. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Consult prescriber if breast-feeding.
Additional Information: 1 g of resin binds approximately 1 mEq of potassium
Anesthesia and Critical Care Concerns/Other Considerations: While sodium polystyrene sulfonate can be used in the treatment of hyperkalemia, if hyperkalemia is associated with ECG changes, more emergent therapy needs to be used (ie, glucose-insulin or calcium). Sodium polystyrene sulfonate should be used with caution in patients with severe heart failure, hypertension, or renal failure. While rectal administration of sodium polystyrene sulfonate achieves a more rapid action, oral administration results in a more sustained potassium reduction.
Cardiovascular Considerations: While Kayexalate�(r) can be used in the treatment of hyperkalemia, if hyperkalemia is associated with ECG changes, more emergent therapy needs to be used (ie, glucose-insulin or calcium). ECG signs of hyperkalemia that require acute interventional measures include peaked T waves, QRS prolongation, and cardiac conduction abnormalities including heart block. Kayexalate�(r) can be used as an additional measure for maintaining control of potassium levels. Note that the mechanism of action consists of an exchange of potassium for sodium, therefore, Kayexalate�(r) should be used with caution in patients with severe heart failure, hypertension, or renal failure. While rectal administration of Kayexalate�(r) achieves a more rapid action, oral administration results in a more sustained potassium reduction.
Dental Health: Effects on Dental Treatment: No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions: No information available to require special precautions
Dosage Forms: Powder for suspension, oral/rectal: Kayexalate�(r): 480 g Kionex™: 454 g Suspension, oral/rectal: 15 g/60 mL (60 mL, 120 mL, 200 mL, 500 mL) [with sorbitol and alcohol] SPS�(r): 15 g/60 mL (60 mL, 120 mL, 480 mL) [contains alcohol 0.3% and sorbitol; cherry flavor]
References: Belanger DR, Tierney MG, and Dickinson G, "Effect of Sodium Polystyrene Sulfonate on Lithium Bioavailability,"Ann Emerg Med, 1992, 21(11):1312-5. Haupt HM and Hutchins GM, "Sodium Polystyrene Sulfonate Pneumonitis,"Arch Intern Med, 1982, 142(2):379-81. Malone TA, "Glucose and Insulin Versus Cation-Exchange Resin for the Treatment of Hyperkalemia in Very Low Birth Weight Infants,"J Pediatr, 1991, 118(1):121-3. Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings,"Chest, 2003, 123(3):897-922. Tomaszewski C, Musso C, Pearson JR, et al, "Lithium Absorption Prevented by Sodium Polystyrene Sulfonate in Volunteers,"Ann Emerg Med, 1992, 21(11):1308-11.
International Brand Names: Kayexalate�(r) (CA); PMS-Sodium Polystyrene Sulfonate (CA)
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