II. Indications
- Symptomatic Hyperkalemia
III. Preparations
IV. Mechanism: Kayexalate
V. Precautions: Kayexalate
- Requires 4-6 hours to lower Potassium
- Not a first-line emergent Hyperkalemia Management tool
- Marginal efficacy
- Potential for lethal colonic necrosis
- Delayed onset of action
- Use other methods to stabilize hyerkalemia in the Emergency Department
- Hyperkalemia stabilization with Calcium
- Consider dextrose and Insulin, Nebulized Albuterol and bicarbonate
- Dialysis if refractory to other measures
-
Drug Interaction with oral medications (decreases absorption of other medications)
- Avoid other oral medications for at least 3 hours before and 3 hours after Kayexalate
- References
- Swaminathan and Herbert in Majoewsky (2013) EM:Rap 13(7): 8
VI. Efficacy: Kayexalate
- Resin with Sorbitol lowered Serum Potassium by 0.5 meq per day
- No effect on Potassium level in End-stage renal disease
VII. Adverse Effects: Kayexalate
- Poorly tolerated
- Fluid Overload
- Acute colonic necrosis
- Rare but typically fatal
- More common with older preparations containing 70% Sorbitol (instead of current 33% Sorbitol)
- However still occurs with non-Sorbitol preparations
- Lillemoe (1987) Surgery 101(3): 267-72 [PubMed]
- McGovan (2009) South Med J 102(5): 493-7 [PubMed]
- Harel (2013) Am J Med 126(3): e9-24 [PubMed]
VIII. Contraindications: Kayexalate
IX. Dosing: Kayexalate
- Oral
- Kayexalate 15 g orally in 50-100 ml of 20% Sorbitol
- Although dosing up to 30-60 g has been used, these doses are not recommended
- May be repeated every 3-4 hours up to 4 doses/day
- Retention Enema
- Kayexalate 30-60 grams
- Dissolve in 200 ml of 20% Sorbitol or 20% D5W
- Retained for 30-60 min (use inflated rectal catheter)
- May repeat every 6 hours up to 4 doses per day
X. References
- Hochman and Patel in Herbert (2013) EM:Rap 13(12): 8-9