Sodium polystyrene sulfonate (Kayexalate) aspiration

Abstract

In this short report we illustrate a case of extensive sodium polystyrene sulfonate (SPS) aspiration as an immediate cause of death in a terminally ill patient. SPS is a cation exchange resin utilized to decrease potassium levels in patients with renal failure. When administered rectally in conjunction with sorbitol, colonic necrosis and perforation have been documented. On the other hand, oral administration can be complicated by aspiration, especially in very ill or debilitated patients. In our current report, histological examination of a patient who aspirated SPS shows multiple polygonal to amorphous basophilic crystalline particles deposited intraalveolarly. The purpose of our report is to familiarize pathologists with the histologic features of this rare iatrogenic complication of therapy for hyperkalemia.

Figure 1

A – Medium power magnification demonstrating purple polygonal intraalveolar kayexalate crystals on a background of emphysematous changes. Scale bar 1000 μm. B – High power magnification showing the SDS crystals in high detail measuring up to 60 μm as well as smaller amorphous ones. Scale bar 20 μm.