Colonic necrosis in a young patient receiving oral kayexalate in sorbitol: case report and literature review

Abstract

Kayexalate (sodium polystyrene sulfonate) is a cation-exchange resin used to treat patients with hyperkalemia. Concomitant administration of kayexalate and sorbitol may induce gastrointestinal injury, which is potentially lethal. However, this well-documented complication is often underrecognized both clinically and pathologically. We propose a typical case along with colonoscopic photos and microscopic pictures. Additionally, we also present a review of the literature on this rare drug-induced side effect.

Figure 1

The colonscopy showed multiple ulcers over splenic flexure. The endoscopic appearance of the colon ulcers included scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement. The pictures were compatible with ischemic colitis.

Figure 2

Kayexalate crystals (A) either floating in ulcerated debris (B) or embedded in colonic lamina propria [hematoxylin and eosin; original magnification (A) 400×, (B) 200×].

Figure 3

Staining properties of kayexalate crystals. (A) Magenta in periodic acid‐Schiff stain (original magnification 400×). (B) Unstained in Congo red stain (original magnification 400×).