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Kayexalate

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1. A shortage of Kayexalate leads to an ER visit

A shortage of Kayexalate leads to an ER visit A shortage of Kayexalate leads to an ER visit A shortage of Kayexalate leads to an ER visit | | February 21, 2019 2 Shares Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock. It happened to be on a Tuesday night with my Suboxone group starting (...) at the same time. Instead, the emergency room doctor gave him Kayexalate, because the hospital had it in stock. He probably didn’t know that wasn’t an option for us. I looked like an idiot to him, but that often happens in primary care. I had gotten over my frustration and embarrassment when, this week, I had a patient on warfarin with a supratherapeutic INR and no active bleeding. I’ve never been nervous about those situations but this was a high number, and Up-To-Date suggested vitamin K, orally because

2019 KevinMD blog

2. An electronic alert to decrease Kayexalate ordering (Full text)

An electronic alert to decrease Kayexalate ordering Important safety concerns have recently emerged regarding the use of sodium polystyrene sulfonate (Kayexalate), a cation-exchange resin commonly used for the treatment of hyperkalemia. We implemented an electronic alert system at a tertiary care academic medical center to warn providers of the safety concerns of Kayexalate. We assessed the number of Kayexalate prescriptions per month, as well as the number of grams of Kayexalate ordered per (...) month, one year before versus one year after implementing the alert. The mean (±SD) number of Kayexalate orders decreased from 123 (±12) to 76 (±14) orders/month (38% absolute reduction, p < 0.001) after implementing the alert. Additionally, the mean (±SD) amount of Kayexalate prescribed decreased from 3332 (±329) to 1885 (±358) g/month (43% absolute reduction, p < 0.001). We conclude that an electronic alert is an effective tool to decrease Kayexalate ordering.

2016 Renal failure PubMed

3. Total colectomy for colon perforation after kayexalate administration: a case report and literature review of a rare complication (Full text)

Total colectomy for colon perforation after kayexalate administration: a case report and literature review of a rare complication Kayexalate is an ion exchange resin that is commonly used to acutely treat patients with hyperkalemia. Bowel ulceration and necrosis is a rare and uncommonly recognized complication of kayexalate administration. More often, concomitant administration with sorbitol is reported to damage the bowel; however, there are reports of kayexalate administration causing bowel (...) necrosis without sorbitol. We present a case of a critically ill patient who underwent total colectomy for colonic necrosis secondary to oral kayexalate administration that was not recognized until late in the pathologic process. We also review the literature to further investigate this progression.Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

2016 Journal of surgical case reports PubMed

4. Kayexalate

Kayexalate Kayexalate Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Kayexalate Kayexalate Aka: Kayexalate , Cation-Exchange Resin (...) , Sodium Polystyrene Sulfonate II. Indications Symptomatic III. Mechanism Cation exchange resin that releases and binds Each gram of Kayexalate contains a resin that binds 1 meq/L was added to decrease associated with the resin reduces as much (or as little) as the binding resin IV. Precautions Requires 4-6 hours to lower Not a first-line emergent tool Marginal efficacy Potential for lethal colonic necrosis Delayed onset of action Use other methods to stabilize hyerkalemia in the Emergency Department

2018 FP Notebook

5. Kayexalate: What is it and does it work?

Kayexalate: What is it and does it work? Kayexalate: What is it and does it work? – Clinical Correlations Search Kayexalate: What is it and does it work? December 1, 2010 6 min read By Todd Cutler, MD Faculty Peer Reviewed A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day (...) five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of 5.9 mEq/L. His EKG is unchanged from admission. His furosemide is discontinued and he is given 15g of Kayexalate. Overnight he has a large bowel movement. The next morning his creatinine is 1.9 mg/dL and his potassium is 5.1 mEq/L. Should Kayexalate be used in the management of hyperkalemia? Developed in the 1930s, .[1] Once introduced

2010 Clinical Correlations

6. Taking a Second Look at Kayexalate (Full text)

Taking a Second Look at Kayexalate 27621500 2016 09 13 2018 11 13 0018-5787 50 11 2015 Nov Hospital pharmacy Hosp Pharm Taking a Second Look at Kayexalate. 959-60 10.1310/hpj5011-959 Malone Dennis J DJ Staff Pharmacist, Providence Health System , St. Peter Hospital, 413 Lilly Rd NE, Olympia, WA 98506 ; phone: 360-493-7411 ; e-mail: dennis.malone@providence.org. eng Editorial 2015 11 24 United States Hosp Pharm 0043175 0018-5787 2016 9 14 6 0 2016 9 14 6 0 2016 9 14 6 1 ppublish 27621500 10.1310

2015 Hospital pharmacy PubMed

7. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. (PubMed)

Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Sodium polystyrene sulfonate (Kayexalate; Sanofi-Aventis, Paris, France) is a cation-exchange resin routinely used in the management of hyperkalemia. However, its use has been associated with colonic necrosis and other fatal gastrointestinal adverse events. Although the addition of sorbitol to sodium polystyrene sulfonate preparations was previously believed to be the cause

2013 The American journal of medicine

8. Kayexalate

Kayexalate Kayexalate Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Kayexalate Kayexalate Aka: Kayexalate , Cation-Exchange Resin (...) , Sodium Polystyrene Sulfonate II. Indications Symptomatic III. Mechanism Cation exchange resin that releases and binds Each gram of Kayexalate contains a resin that binds 1 meq/L was added to decrease associated with the resin reduces as much (or as little) as the binding resin IV. Precautions Requires 4-6 hours to lower Not a first-line emergent tool Marginal efficacy Potential for lethal colonic necrosis Delayed onset of action Use other methods to stabilize hyerkalemia in the Emergency Department

2015 FP Notebook

9. Chiefs’ inquiry corner

polystyrene sulfonate (SPS) – also known as Kayexalate – is a cation-exchange resin that assists in the elimination of potassium via the GI tract. SPS has been FDA approved for the treatment of hyperkalemia since the late 1950s. However, in 2009, the FDA issued a black box warning against the use of sorbitol-containing preparations of SPS due to the proposed risk of intestinal necrosis as demonstrated by multiple case reports. Additional case reports exist in which SPS has been linked to bowel necrosis

2019 Clinical Correlations

10. Colonic necrosis due to sodium polystyrene sulfate (Kayexalate) (Full text)

Colonic necrosis due to sodium polystyrene sulfate (Kayexalate) 19751641 2009 10 08 2018 11 13 1532-8171 27 6 2009 Jul The American journal of emergency medicine Am J Emerg Med Colonic necrosis due to sodium polystyrene sulfate (Kayexalate). 753.e1-2 10.1016/j.ajem.2008.10.002 Bomback Andrew S AS Division of Nephrology and Hypertension, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. abomback@unch.unc.edu Woosley John T JT

2009 The American journal of emergency medicine PubMed

11. CRACKCast E124 – Acid-Base Disorders

of Normal Anion Gap Metabolic Acidosis (Box 116.4) GI HCO 3 – Loss Diarrhea Colostomy or ileostomy Enteric fistulas Ion exchange resins (ex. Kayexalate) Renal HCO 3 – Loss Renal tubular acidosis Tubulointerstitial renal disease Hyperparathyroidism Rapid normal saline infusion Urologic procedures Ureterosigmoidostomy Ureteroileal conduit Ingestions Acetazolamide Calcium chloride Magnesium sulfate Other Hypoaldosteronism Hyperkalemia Toluene NOTE: Overall, a normal anion gap does not exclude clinically

2017 CandiEM

12. Test almost all of your most important ECG rhythm interpretation skills with this case.

insulin, and 10mg albuterol nebulizer. Kayexalate was also given later. Repeat ECG several hours later: QRS duration has decreased significantly, now 148 msec, which is near the baseline from last admission which was recorded with normal potassium level. PR interval has decreased 182 msec. Luckily she did not experience any rhythm or cardiovascular deterioration before hyperkalemia therapy, and the treatment was successful in lowering the K. Labs two hours after treatments showed K = 7.0, which

2017 Dr Smith's ECG Blog

13. Treatment of Severe Hyperkalemia: Confronting 4 Fallacies (Full text)

in the treatment of severe hyperkalemia: sodium bicarbonate, sodium polystyrene sulfonate (Kayexalate [Concordia Pharmaceuticals Inc., Oakville, ON, Canada], SPS [CMP Pharma, Farmville, NC]), and hemodialysis with low potassium dialysate. After reviewing older reports and newer information, I believe that these exclusions are ill advised. In this article, I briefly discuss the treatment of severe hyperkalemia and detail why these modalities are safe and effective and merit inclusion in the treatment of severe

2017 Kidney international reports PubMed

14. The Role of the Gut for Potassium Homeostasis in CKD

have large randomized placebo controlled trials confirming their effectiveness, now seem bound to replace the ancient but much experienced Kayexalate (Sodium Polystyrene Sulfonate; SPS) for the management of hyperkalemia. However, they are not approved in Canada and their cost makes them less enticing options in a publicly funded health care system. Also, what about safety concerns? SPS has been used since the 1950s, however it took decades for case reports to come out possibly linking fatal colon (...) necrosis to Kayexalate use. This association remains hotly debated. A found a total of 58 cases of biopsy confirmed bowel injury that were “possibly” related to SPS use based on the WHO causality criteria. Interestingly, these cases were not limited to patients using SPS with sorbitol, nor to the post-operative population as was once thought to be the major risk factors for adverse GI events from SPS. On the other hand, a r over a 10 year period found only 3 cases of colon necrosis among 2,194 patients

2018 Renal Fellow Network

15. LITFL Review 303

-sized chunk of Global FOAM. The Most Fair Dinkum Ripper Beauts of the Week Kenneth Palmer from Karolinska shares his in a podcast from the Maryland CCProject. [SO] The Best of Emergency Medicine We’ve known for some time that Kayexalate is generally ineffective in our patients, and comes with some untoward side effects. But an important piece from PulmCCM reveals that ! [RP] ERCast podcast on reviews recent articles on abscess, c-spine clearance in intoxicated patients, lytics in PE and much, much

2017 Life in the Fast Lane Blog

17. Spontaneous conversion of atrial fibrillation caused by severe hyperkalemia: A case report. (Full text)

to sinus rhythm due to hyperkalemia. Besides, he developed secondary thrombosis caused by abrupt termination of atrial fibrillation.This patient was diagnosed with hyperkalemia, hypertension, and AF.He was treated with an intravenous infusion of calcium gluconate, insulin and dextrose, an oral kayexalate, and emergency hemodialysis.The patient was managed effectively and discharged with stable status.Hyperkalemia could induce malignant arrhythmia with high mortality. Thus we suggested more attention

2018 Medicine PubMed

18. The Successful Treatment of Sodium Polystyrene Sulfonate-induced Enteritis Diagnosed by Small Bowel Endoscopy (Full text)

The Successful Treatment of Sodium Polystyrene Sulfonate-induced Enteritis Diagnosed by Small Bowel Endoscopy Sodium polystyrene sulfonate (SPS: Kayexalate®) is an ion-exchange resin used to treat hyperkalemia in patients with chronic kidney disease. It is known that this resin sometimes causes colonic necrosis and perforation, but there are few reports about small bowel necrosis associated with SPS. We herein report the case of a patient who developed SPS-induced small bowel necrosis, which

2018 Internal Medicine PubMed

19. Sodium polystyrene sulfonate crystals in the gastric wall of a patient with upper gastrointestinal bleeding and gastric perforation: an incidental finding or a pathogenic factor? (Full text)

Sodium polystyrene sulfonate crystals in the gastric wall of a patient with upper gastrointestinal bleeding and gastric perforation: an incidental finding or a pathogenic factor? Sodium polystyrene sulfonate, or Kayexalate, is an ion-exchange resin used to treat hyperkalemia. It is sometimes used with sorbitol, an osmotic laxative that prevents constipation. Small and large bowel necrosis and perforation due to Kayexalate were previously reported. However, no previous cases of gastric (...) was performed. Pathological examination revealed no abnormalities except fibrinoleukocytic debris with Kayexalate crystals in the gastric wall. Kayexalate is believed to be a trigger for the gastric injury in a patient with tissues impaired by corticosteroids, CKD and immunosuppressors.

2018 Journal of surgical case reports PubMed

20. Potassium Reduction Initiative to Optimize RAAS Inhibition Therapy With Sodium Zirconium Cyclosilicate in Heart Failure

hypersensitivity to ZS. Any condition outside the cardiovascular (CV) and renal disease area, such as but not limited to malignancy, with a life expectancy of less than 2 years based on investigator´s clinical judgement. Active malignancy requiring treatment. Current treatment with MRA, including spironolactone, eplerenone, canrenone, canrenoate, or finerenone, at any dose at enrolment. Treated with potassium binding resins such as sodium polystyrene sulfonate (SPS;e.g. Kayexalate®) or calcium polystyrene

2018 Clinical Trials

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