• autopsy findings
• bowel perforation
• cation-exchange resin
• drug-induced bowel injury
• extraintestinal crystal deposition
• sodium polystyrene sulfonate

• gastrointestinal adverse events
• polystyrene sulfonate
• sevelamer

• Humans
• Chelating Agents/adverse effects
• Gastrointestinal Diseases/chemically induced
• Gastrointestinal Diseases/pathology
• Gastrointestinal Tract/pathology
• Gastrointestinal Tract/drug effects
• Necrosis/chemically induced
• Polystyrenes/adverse effects
• Renal Dialysis
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/drug therapy
• Renal Insufficiency, Chronic/epidemiology
• Risk Factors
• Sevelamer/adverse effects

Sodium polystyrene sulfonate (SPS) is commonly prescribed for the management of hyperkalemia, a critical electrolyte imbalance contributing to over 800000 annual visits to emergency departments.

To conduct a systematic review of documented cases of SPS-induced colitis and assess its associated prognosis.

Following the PRISMA-P guidelines, our study employed Medical Subject Headings and Health Sciences Descriptors, skillfully combined using Boolean operators, to conduct comprehensive searches across various electronic databases, including Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Language criteria were confined to English, Spanish, and Portuguese, with no limitations on the publication date. Additionally, we manually scrutinized the reference lists of retrieved studies. To present our findings, we utilized simple descriptive analysis.

Our search strategy yielded a total of 442 references. After rigorous evaluation, we included 51 references, encompassing 59 documented cases of colitis. Predominant clinical presentations included abdominal pain, observed in 35 (60.3%) cases, and bloating, reported in 18 (31%) cases. The most frequently affected sites of inflammation were the cecum, rectum, and small intestine, accounting for 31%, 25.8%, and 22.4% of cases, respectively. Colonoscopy findings were described in 28 (48.2%) cases, and 29 (50%) of patients required surgical intervention. Among the subset of patients for whom outcome data was available, 39 (67.2%) experienced favorable outcomes, while 12 (20.6%) unfortunately succumbed to the condition. The mean time required for resolution was 36.7 d, with a range spanning from 1 to 120 d.

SPS demonstrates the capacity to effectively lower serum potassium levels within 24 h. However, this benefit is not without the risk of bowel injury. Our study highlights the absence of high-quality data pertaining to the incidence of adverse events associated with SPS usage, making it challenging to determine whether the potential risks outweigh the benefits. However, a significant mortality rate related to SPS-induced colitis was noted. Future investigations should prioritize randomized controlled trials with a sufficiently large patient cohort to ascertain the true utility and safety profile of this medication.

• Sodium polystyrene sulfonate
• Hyperkalemia
• Colitis
• Bowel necrosis
• Kayexalate

• dietary potassium
• diuretics
• hyperkalemia
• novel potassium binders
• renin-angiotensin-aldosterone inhibitors (RAAS inhibitors)
• sodium-glucose transporter 2 inhibitors (SGLT2 inhibitors)

• Calcium polystyrene sulfonate
• Colonic injury
• Colonic necrosis
• Gastrointestinal hemorrhage
• Kalimate

• Kalimate
• Kayexalate
• gastrointestinal injury
• hyperkalemia

• financial

• Diabetes
• Diabetic kidney disease
• Mineralocorticoid receptor antagonist

• Adult
• Albuminuria/drug therapy
• Aldosterone/metabolism
• Angiotensin-Converting Enzyme Inhibitors/adverse effects
• Angiotensin-Converting Enzyme Inhibitors/therapeutic use
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/prevention & control
• Diabetes Mellitus, Type 2/complications
• Diabetes Mellitus, Type 2/drug therapy
• Diabetic Nephropathies/etiology
• Diabetic Nephropathies/physiopathology
• Humans
• Hyperkalemia/etiology
• Mineralocorticoid Receptor Antagonists/adverse effects
• Mineralocorticoid Receptor Antagonists/therapeutic use
• Naphthyridines/adverse effects
• Naphthyridines/therapeutic use
• Renin/antagonists & inhibitors
• Renin-Angiotensin System/drug effects

• CIHR

• chronic kidney disease
• small bowel necrosis
• sodium polystyrene sulfonate

• Aged
• Cation Exchange Resins/adverse effects
• Endoscopy, Gastrointestinal
• Enteritis/chemically induced
• Enteritis/diagnostic imaging
• Enteritis/pathology
• Enteritis/surgery
• Humans
• Hyperkalemia/drug therapy
• Hyperkalemia/etiology
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Intestine, Small/surgery
• Laparoscopy
• Male
• Necrosis/chemically induced
• Polystyrenes/adverse effects
• Renal Insufficiency, Chronic/complications
• Tomography, X-Ray Computed

Hyperkalemia is a commonly encountered medical problem. The treatment of hyperkalemia involves the use of pharmacological agents with different mechanism of actions. Sodium Polystyrene sulfonate (SPS) is a cation-exchange resin that exchanges sodium for potassium. In 2009, the United States Food and Drug Administration issued warning against the use of SPS with sorbitol due to risk of colonic necrosis. We present a case of SPS induced colonic necrosis in the absence of sorbitol and risk factors deemed to increase risk of colonic necrosis.

Here we report a 64-year old male with past medical history of kidney stones who was admitted for treatment of colitis which was complicated by septic shock requiring vasopressors. His course was further complicated by hyperkalemia attributed to acute kidney injury. One dose 30 gm of SPS was administered which normalized his serum potassium. The patient’s course was complicated by duodenal ulcer, and colonic perforation. The initial pathology findings of the resected specimen were suggestive of inflammatory bowel disease which resulted in starting patient on mesalamine. The patient then developed fistula which was resected and sent for pathology. SPS induced colonic necrosis was made based on the pathology findings.

SPS is commonly used to decrease potassium levels. SPS has been reported to be associated with several gastrointestinal complications. FDA issued warning against the use of SPS in patients at risk for complications. Here we report a case with SPS induced colonic necrosis in the absence of risk factors reported in the literature.

• Hyperkalemia
• Intestinal necrosis
• Sodium polystyrene sulfonate

• Calcium polystyrene sulfonate
• Hepatic portal venous gas
• Ileocecal ulcer

• Cation-exchange resin
• Heart failure
• Hyperkalemia
• Patiromer
• Renin-angiotensin-aldosterone system
• Sodium zirconium cyclosilicate

Calcium polystyrene sulfonate (CPS) has long been used to treat hyperkalemia in patients with chronic kidney disease (CKD). However, its efficacy and safety profile have not been systematically explored. We investigated the long-term efficacy of oral CPS for treating mild hyperkalemia on an outpatient basis.

We performed a retrospective analysis of ambulatory CKD patients who were prescribed CPS for > 1 week because of elevated serum potassium levels > 5.0 mmol/L. Patients were divided into four groups according to the length of time that they took a fixed dosage of CPS (Group 1, < 3 months; Group 2, 3–6 months; Group 3, 6–12 months; and Group 4, > 1 year). Response was defined as a decrease in the serum potassium level (> 0.3 mmol/L) after treatment with CPS.

We enrolled a total of 247 adult patients with a basal eGFR level of 30 ± 15 mL/min/1.73 m². All patients took small doses of CPS (8.0 ± 3.6 g/d), and serum potassium decreased in a dose-dependent fashion. Serum potassium of all patients decreased significantly from 5.8 ± 0.3 mmol/L to 4.9 ± 0.7 mmol/L with CPS treatment (P < 0.001). The response rates were 79.9%, 71.4%, 66.7%, and 86.8% in Groups 1, 2, 3, and 4, respectively. No serious adverse effects were reported during CPS administration, though constipation was noted in 19 patients (8%).

Small doses of oral CPS are effective and safe for controlling mild hyperkalemia in CKD patients over a long period of time.

• Administration, Oral
• Aged
• Chelating Agents/administration & dosage
• Female
• Humans
• Hyperkalemia/blood
• Hyperkalemia/drug therapy
• Hyperkalemia/etiology
• Male
• Middle Aged
• Polystyrenes/administration & dosage
• Potassium/blood
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/drug therapy
• Retrospective Studies
• Treatment Outcome

Kayexalate is an ion exchange resin that is commonly used to acutely treat patients with hyperkalemia. Bowel ulceration and necrosis is a rare and uncommonly recognized complication of kayexalate administration. More often, concomitant administration with sorbitol is reported to damage the bowel; however, there are reports of kayexalate administration causing bowel necrosis without sorbitol. We present a case of a critically ill patient who underwent total colectomy for colonic necrosis secondary to oral kayexalate administration that was not recognized until late in the pathologic process. We also review the literature to further investigate this progression.

To define the role of gastrointestinal (GI) decontamination of the poisoned patient.

A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.

Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.

The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.

The current literature supports limited use of GI decontamination of the poisoned patient.