II. Indications

  1. Symptomatic Hyperkalemia

III. Preparations

  1. Sodium Polystyrene Sulfonate (Kayexalate)
    1. Older agent, developed in the 1960s, and described on this page
  2. Newer Potassium binders (see linked pages)
    1. Patiromer (Veltassa)
    2. Zirconium Cyclosillicate (Lokelma)

IV. Mechanism: Kayexalate

  1. Cation exchange resin that releases Sodium and binds Potassium
  2. Each gram of Kayexalate contains a resin that binds 1 meq/L Potassium
  3. Sorbitol was added to decrease Constipation associated with the resin
    1. Sorbitol reduces Potassium as much (or as little) as the binding resin

V. Precautions: Kayexalate

  1. Requires 4-6 hours to lower Potassium
  2. Not a first-line emergent Hyperkalemia Management tool
    1. Marginal efficacy
    2. Potential for lethal colonic necrosis
    3. Delayed onset of action
  3. Use other methods to stabilize hyerkalemia in the Emergency Department
    1. Hyperkalemia stabilization with Calcium
    2. Consider dextrose and Insulin, Nebulized Albuterol and bicarbonate
    3. Dialysis if refractory to other measures
  4. Drug Interaction with oral medications (decreases absorption of other medications)
    1. Avoid other oral medications for at least 3 hours before and 3 hours after Kayexalate
  5. References
    1. Swaminathan and Herbert in Majoewsky (2013) EM:Rap 13(7): 8

VI. Efficacy: Kayexalate

VII. Adverse Effects: Kayexalate

  1. Poorly tolerated
  2. Fluid Overload
  3. Acute colonic necrosis
    1. Rare but typically fatal
    2. More common with older preparations containing 70% Sorbitol (instead of current 33% Sorbitol)
    3. However still occurs with non-Sorbitol preparations
    4. Lillemoe (1987) Surgery 101(3): 267-72 [PubMed]
    5. McGovan (2009) South Med J 102(5): 493-7 [PubMed]
    6. Harel (2013) Am J Med 126(3): e9-24 [PubMed]

VIII. Contraindications: Kayexalate

IX. Dosing: Kayexalate

  1. Oral
    1. Kayexalate 15 g orally in 50-100 ml of 20% Sorbitol
    2. Although dosing up to 30-60 g has been used, these doses are not recommended
    3. May be repeated every 3-4 hours up to 4 doses/day
  2. Retention Enema
    1. Kayexalate 30-60 grams
    2. Dissolve in 200 ml of 20% Sorbitol or 20% D5W
    3. Retained for 30-60 min (use inflated rectal catheter)
    4. May repeat every 6 hours up to 4 doses per day

X. References

  1. Hochman and Patel in Herbert (2013) EM:Rap 13(12): 8-9

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Related Studies

Cost: Medications

sodium polystyrene sulfonate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)

Ontology: Cation Exchange Resins (C0007445)

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
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