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Case Reports
. 2021 May 11;8(5):e00585.
doi: 10.14309/crj.0000000000000585. eCollection 2021 May.

Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

Eduardo Dantas  1 , Mariana Coelho  1 , Cristiana Sequeira  1 , Inês Santos  1 , Cláudio Martins  1 , Cláudia Cardoso  1 , Ricardo Freire  1 , Ana Paula Oliveira  1
Affiliations
Case Reports

Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

Eduardo Dantas et al. ACG Case Rep J. .

Abstract

Sodium polystyrene sulfonate (kayexalate) is a cation-exchange resin widely used in the management of hyperkalemia. Gastrointestinal adverse events are uncommon; symptoms are nonspecific, and mucosal injury can range from mild ulceration to bowel perforation. An 81-year-old man was admitted because of decompensation of cirrhosis with acute kidney injury and hyperkalemia, treated with sodium polystyrene sulfonate. During admission, he presented multiple episodes of hematochezia, accompanied by tachycardia and hemoglobin drop. Colonoscopy revealed colonic ulceration, and histopathological findings were compatible with ulceration due to kayexalate injury. Despite rare, the widespread use of sodium polystyrene sulfonate puts a large population at risk of serious complications related to its use.

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Figures

Figure 1.
Figure 1.
Colonoscopy revealing bright red blood in the descending colon, originating from a large adherent clot obscuring an area of ulcerated mucosa.
Figure 2.
Figure 2.
Histology: ulceration area with deposits of kayexalate crystals (hematoxylin and eosin stain, 40× magnification).
Figure 3.
Figure 3.
Repeat colonoscopy, with area of ulceration and evidence of re-epithelization.
See this image and copyright information in PMC

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References

    1. Kessler C, Ng J, Valdez K, Xie H, Geiger B. SPS in hyperkalemia. J Hosp Med 2011;3:136–40. - PubMed
    1. Saleh Almulhim A, Hall E, Mershid Al Rehaili B, Saleh Almulhim A. Sodium polystyrene sulfonate induced intestinal necrosis; a case report. Saudi Pharm J 2018;26:771–4. - PMC - PubMed
    1. Cheng ES, Stringer KM, Pegg SP. Colonic necrosis and perforation following oral sodium polystyrene sulfonate (resonium A/kayexalate) in a burn patient. Burns 2002;28:189–90. - PubMed
    1. Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM. Intestinal necrosis due to sodium polystyrene (kayexalate) in sorbitol enemas: Clinical and experimental support for the hypothesis. Surgery 1987;101:267–72. - PubMed
    1. Gerstman BB, Kirkman R, Platt R. Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol. Am J Kidney Dis 1992;20(2):159–61. - PubMed

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