Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Nov 9:2017:bcr2017221790.
doi: 10.1136/bcr-2017-221790.

Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis

Roberto Christian Cerrud-Rodriguez  1 , Diego Alcaraz-Alvarez  1 , Brian Bobby Chiong  2 , Abdurhman Ahmed  1
Affiliations
Case Reports

Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis

Roberto Christian Cerrud-Rodriguez et al. BMJ Case Rep. .

Abstract

We present the case report of an 80-year-old woman with chronic kidney disease stage G5 admitted to the hospital with fluid overload and hyperkalaemia. Sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol suspension was given orally to treat her hyperkalaemia, which precipitated an episode of SPS in sorbitol-induced ischaemic colitis with the subsequent complication of vancomycin-resistant Enterococcus (VRE) bacteraemia. SPS (Kayexalate) in sorbitol suspension has been implicated in the development of intestinal necrosis. Sorbitol, which is added as a cathartic agent to decrease the chance of faecal impaction, may be primarily responsible through several proposed mechanisms. The gold standard of diagnosis is the presence of SPS crystals in the colon biopsy. On a MEDLINE search, no previous reports of a VRE bacteraemia as a complication of biopsy-confirmed SPS in sorbitol ischaemic colitis were found. To the best of our knowledge, ours would be the first such case ever reported.

Keywords: contraindications and precautions; drugs: gastrointestinal system; endoscopy; gi bleeding; infectious diseases.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT with oral contrast shows bowel wall thickening at ascending colon and proximal transverse colon. There are foci of air in the bowel wall concerning for pneumatosis coli. Finding is compatible with colitis. Evaluation is limited owing to lack of intravenous contrast.
Figure 2
Figure 2
CT with intravenous contrast again shows bowel wall thickening at ascending and proximal transverse colon. There is mucosal enhancement and areas of contrast extravasation (arrows) compatible with reperfusion injury and active bleeding.
Figure 3
Figure 3
CT with intravenous contrast shows patent coeliac artery.
Figure 4
Figure 4
CT with intravenous contrast shows patent distal superior mesenteric artery (blue arrow) and patent inferior mesenteric artery (red arrow).
Figure 5
Figure 5
Pathology slide of our patient’s colonic biopsy showing an amorphous basophilic crystalline material, morphologically compatible with sodium polystyrene sulfonate (Kayexalate) crystal.
See this image and copyright information in PMC

References

    1. Chou YH, Wang HY, Hsieh MS. Colonic necrosis in a young patient receiving oral kayexalate in sorbitol: case report and literature review. Kaohsiung J Med Sci 2011;27:155–8. 10.1016/j.kjms.2010.12.010 - DOI - PMC - PubMed
    1. Sterns RH, Rojas M, Bernstein P, et al. . Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? J Am Soc Nephrol 2010;21:733–5. 10.1681/ASN.2010010079 - DOI - PubMed
    1. McGowan CE, Saha S, Chu G, et al. . Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol. South Med J 2009;102:493–7. 10.1097/SMJ.0b013e31819e8978 - DOI - PMC - PubMed
    1. United States Food and Drug Administration. Kayexalate SODIUM POLYSTYRENE SULFONATE, USP Cation-Exchange Resin, 2010https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011287s023lbl.pdf (accessed 24 Jun 2017).
    1. O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist 2015;8:217–30. 10.2147/IDR.S54125 - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources