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Case Reports
. 2019 Jul;98(30):e16574.
doi: 10.1097/MD.0000000000016574.

Successful management of severe acute respiratory distress syndrome caused by sodium polystyrene sulfonate aspiration: A case report

Cheng-Yu Ko  1 , Ping-Yen Liu  1   2 , Po-Wei Chen  1   2
Affiliations
Case Reports

Successful management of severe acute respiratory distress syndrome caused by sodium polystyrene sulfonate aspiration: A case report

Cheng-Yu Ko et al. Medicine (Baltimore). 2019 Jul.

Abstract

Rationale: Sodium polystyrene sulfonate is commonly administered to treat hyperkalemia. Severe pneumonia due to aspiration of this drug is rare and no survival case has thus far been reported.

Patient concerns: A 45-year-old man was hospitalized for acute decompensated heart failure and acute kidney injury with hyperkalemia. He aspirated sodium polystyrene sulfonate while consuming the drug. Severe acute respiratory distress syndrome (ARDS) developed rapidly, and he was transferred to the intensive care unit (ICU).

Diagnoses: Chest radiography results after aspiration showed new consolidation in the left upper lung. He underwent emergency bronchoscopy, which revealed a considerable amount of yellow mud-like material in the trachea and bronchi. Chest radiography results after the bronchoscopic removal of the foreign material revealed rapid resolution of the left upper lung consolidation.

Interventions: In the ICU, mechanical ventilation with low tidal volume and high positive end-expiratory pressure was administered and extracorporeal membrane oxygenation (ECMO) was set up for treating severe ARDS. We arranged an emergency bronchoscopy for diagnosis and removal of polystyrene sulfonate.

Outcomes: ECMO was discontinued after 10 days and the patient was discharged after approximately 2 weeks.

Lessons: Aspiration of sodium polystyrene sulfonate is not common but can be lethal. Clinicians should be cautious and appropriately inform patients of the aspiration risk while administering this drug. Mechanical ventilation and bronchoscopy were effective treatments for severe ARDS caused by aspiration of this drug.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A, Chest radiograph after sodium polystyrene sulfonate aspiration exhibited a new consolidation in the left upper lung. B, After bronchoscopic removal of the foreign material, rapid resolution of left upper lung consolidation was observed 4 hours after the aspiration episode.
Figure 2
Figure 2
Yellow mud-like material that appeared similar to the powder of sodium polystyrene sulfonate was removed using emergency bronchoscopy.
See this image and copyright information in PMC

References

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