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Case Reports
. 2018 Sep;26(6):771-774.
doi: 10.1016/j.jsps.2018.04.008. Epub 2018 Apr 12.

Sodium polystyrene sulfonate induced intestinal necrosis; a case report

Abdulaziz Saleh Almulhim  1   2 , Edina Hall  3 , Bassam Mershid Al Rehaili  4 , Abdulmuhsin Saleh Almulhim  5
Affiliations
Case Reports

Sodium polystyrene sulfonate induced intestinal necrosis; a case report

Abdulaziz Saleh Almulhim et al. Saudi Pharm J. 2018 Sep.

Abstract

Background: Hyperkalemia is a commonly encountered medical problem. The treatment of hyperkalemia involves the use of pharmacological agents with different mechanism of actions. Sodium Polystyrene sulfonate (SPS) is a cation-exchange resin that exchanges sodium for potassium. In 2009, the United States Food and Drug Administration issued warning against the use of SPS with sorbitol due to risk of colonic necrosis. We present a case of SPS induced colonic necrosis in the absence of sorbitol and risk factors deemed to increase risk of colonic necrosis.

Case report: Here we report a 64-year old male with past medical history of kidney stones who was admitted for treatment of colitis which was complicated by septic shock requiring vasopressors. His course was further complicated by hyperkalemia attributed to acute kidney injury. One dose 30 gm of SPS was administered which normalized his serum potassium. The patient's course was complicated by duodenal ulcer, and colonic perforation. The initial pathology findings of the resected specimen were suggestive of inflammatory bowel disease which resulted in starting patient on mesalamine. The patient then developed fistula which was resected and sent for pathology. SPS induced colonic necrosis was made based on the pathology findings.

Conclusion: SPS is commonly used to decrease potassium levels. SPS has been reported to be associated with several gastrointestinal complications. FDA issued warning against the use of SPS in patients at risk for complications. Here we report a case with SPS induced colonic necrosis in the absence of risk factors reported in the literature.

Keywords: Hyperkalemia; Intestinal necrosis; Sodium polystyrene sulfonate.

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Figures

Image 1
Image 1
Abdominal CT scan showing perforated colon with air-fluid collection in the hemiabdomen.
Image 2
Image 2
Abdominal CT scan showing enterocutanous fistula.
See this image and copyright information in PMC

References

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