Document Detail


Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review.
MedLine Citation:
PMID:  23321430     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Ziv Harel; Shai Harel; Prakesh S Shah; Ron Wald; Jeffrey Perl; Chaim M Bell
Publication Detail:
Type:  Journal Article; Review     Date:  2013-01-12
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-04-11     Revised Date:  2013-10-08    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264.e9-24     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada. harelz@smh.ca
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MeSH Terms
Descriptor/Qualifier:
Cation Exchange Resins / administration & dosage,  adverse effects*,  toxicity
Colonic Diseases / chemically induced
Drug Therapy, Combination
Female
Gastrointestinal Diseases / chemically induced*,  pathology
Gastrointestinal Tract / pathology
Humans
Male
Middle Aged
Necrosis / chemically induced
Polystyrenes / administration & dosage,  adverse effects*,  toxicity
Sorbitol / administration & dosage,  adverse effects,  toxicity
Chemical
Reg. No./Substance:
0/Cation Exchange Resins; 0/Polystyrenes; 28210-41-5/polystyrene sulfonic acid; 50-70-4/Sorbitol
Comments/Corrections
Comment In:
Am J Med. 2013 Sep;126(9):e15   [PMID:  23968907 ]
Am J Med. 2013 Sep;126(9):e13   [PMID:  23968906 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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