Document Detail

Necrotizing enterocolitis in a 850 gram infant receiving sorbitol-free sodium polystyrene sulfonate (Kayexalate): clinical and histopathologic findings.
MedLine Citation:
PMID:  17377608     Owner:  NLM     Status:  MEDLINE    
We report a 27-week, 850 g infant with severe Streptococcus group B sepsis and life-threatening hyperkalemia due to progressive anuria. On the fourth day of life, after he failed treatment with diuretics, salbutamol, insulin, calcium gluconate and sodium bicarbonate, he was treated with sorbitol-free Kayexalate enemas. Potassium level slowly decreased from 9.2 mmol/l to normal level along with a recovery of normal urine output. On the 11th day of life, clinical and radiological signs of a perforated necrotizing enterocolitis (NEC) occurred and the patient required surgical intestinal resection. Histologic examination of the ileum specimen revealed areas of necrosis with fibrosis and giant cell reaction to a nonpolarizable material consistent with sodium polystyrene sulfonate. Usually, Kayexalate is suspended in hyperosmolar sorbitol solutions and the elevated osmolarity seems to be responsible for hemorrhagic colitis, transmural necrosis and definitely NEC. Our case report shows that Kayexalate per se, and not necessarily suspended in sorbitol, can lead to gastrointestinal tract complications and NEC in preterm infants.
S Rugolotto; M Gruber; P D Solano; L Chini; S Gobbo; S Pecori
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  27     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-22     Completed Date:  2007-05-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  247-9     Citation Subset:  IM    
Neonatal Intensive Care Unit, Department of Pediatrics, University of Verona, Verona, Italy.
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MeSH Terms
Cation Exchange Resins / adverse effects*
Enterocolitis, Necrotizing / etiology*,  pathology
Hyperkalemia / drug therapy*
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature
Polystyrenes / adverse effects*
Sepsis / pathology
Streptococcal Infections / complications
Streptococcus agalactiae
Reg. No./Substance:
0/Cation Exchange Resins; 0/Polystyrenes; 28210-41-5/polystyrene sulfonic acid

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