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
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Definition (MSH) | High molecular weight insoluble polymers which contain functional anionic groups that are capable of undergoing exchange reactions with cations. |
Concepts | Indicator, Reagent, or Diagnostic Aid (T130) , Biomedical or Dental Material (T122) , Organic Chemical (T109) |
MSH | D002411 |
SnomedCT | 350556000, 372638001 |
English | Cation Exchange Resins, Exchange Resins, Cation, Resins, Cation Exchange, cation exchange resin, Cation Exchangers (Resins), cation exchange resins, Cation exchange resin, Cation exchange resin (product), Cation exchange resin (substance) |
French | Résines échangeuses de cations |
Swedish | Katjonbyteshartser |
Czech | kationtoměniče |
Finnish | Kationinvaihtohartsit |
Russian | SMOLY KATIONOOBMENNYE, KATIONOOBMENNIKI, КАТИОНООБМЕННИКИ, СМОЛЫ КАТИОНООБМЕННЫЕ |
Japanese | 陽イオン交換体(樹脂), 陽イオン交換樹脂, カチオン交換樹脂 |
Polish | Żywice kationowymienne, Kationity |
Spanish | resina de intercambio catiónico (producto), resina de intercambio catiónico (sustancia), resina de intercambio catiónico, Resinas de Intercambio de Catión |
German | Kationenaustauscherharze |
Italian | Resine a scambio cationico |
Portuguese | Resinas de Troca de Cátion |
Ontology: Kayexalate (C0124498)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C003321 |
English | Kayexalate, kayexalate |
Ontology: Sodium polystyrene sulfonate (C0142915)
Definition (NCI) | A potassium ion exchange resin composed of benzene-diethyl polymer with ethenyl-benzene, sulfonated, sodium salt. Administered as an oral suspension, sodium polystyrene sulfonate lowers serum potassium levels by exchanging its sodium ions for potassium ions. Acting primarily in the large intestine, this agent also exchanges its sodium ions for calcium and magnesium ions, resulting in a decrease in serum calcium and magnesium levels. (NCI04) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C003321 |
SnomedCT | 27085003, 387149008 |
English | sodium polystyrene sulfonate, Sodium Polystyrene Sulfonate, Sodium polystyrene sulphonate, ion exchange resins sodium polystyrene sulfonate, sodium polystyrene sulfonate (medication), SODIUM POLYSTYRENE SULFONATE, sodium polystyrene sulphonate, Sodium polystyrene sulfonate, Sodium polystyrene sulfonate (product), Sodium polystyrene sulfonate (substance), Sodium Polystyrene, polystyrene sulfonic acid, homopolymer, sodium salt |
Spanish | sulfonato de poliestireno sódico (producto), sulfonato de poliestireno sódico (sustancia), sulfonato de poliestireno sódico |
Ontology: Potassium Ion Binding Activity [MoA] (C2917239)
Concepts | Molecular Function (T044) |
English | Potassium Binding Activity, Potassium Ion Binding Activity [MoA], Potassium Ion Binding Activity |