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Kayexalate

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41. Extremely Low Birth Weight Infant (Diagnosis)

to the extracellular compartment following delivery. [ ] Normal potassium concentration is recovered in 4–5 days, with an eventual increase in glomerular filtration rate and increased diuresis. However, nonoliguric hyperkalemia has been associated with cardiac arrhythmias and death. [ ] There is no current guideline for the most effective treatment of hyperkalemia in ELBW infants; suggested therapies include insulin with glucose, albuterol inhalation, calcium, diuresis with furosemide, kayexalate and, rarely

2014 eMedicine Pediatrics

42. Metabolic Alkalosis (Diagnosis)

with a cation-exchange resin (eg, sodium polystyrene sulfonate [Kayexalate]); the resin binds the cation, leaving bicarbonate unbound. Thiazides and loop diuretics enhance sodium chloride excretion in the distal convoluted tubule and the thick ascending loop, respectively. These agents cause metabolic alkalosis by chloride depletion and by increased delivery of sodium ions to the collecting duct, which enhances potassium ion and hydrogen ion secretion. Volume depletion also stimulates aldosterone secretion

2014 eMedicine.com

43. Gastritis, Acute (Diagnosis)

. Note the following: Drugs - NSAIDs, such as aspirin, ibuprofen, and naproxen; cocaine; iron; colchicine, when at toxic levels, as in patients with failing renal or hepatic function; kayexalate; chemotherapeutic agents, such as mitomycin C, 5-fluoro-2-deoxyuridine, and floxuridine Potent alcoholic beverages, such as whisky, vodka, and gin Bacterial infections - H pylori (most frequent), H heilmanii (rare), streptococci (rare), staphylococci (rare), Proteus species (rare), Clostridium species (rare

2014 eMedicine.com

44. Uremia (Treatment)

to stabilize cardiac membranes, bicarbonate, insulin and glucose administration, or inhaled or intravenous beta agonists. Nonemergent hyperkalemia can be treated with oral potassium binders (eg, sodium polystyrene sulfonate [Kayexalate]). Correction of acidemia may improve the potassium balance. In addition, it is imperative to discontinue any medicine that might be contributing to the hyperkalemia, including the following: Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-receptor blockers (ARBs

2014 eMedicine.com

45. Hyperchloremic Acidosis (Treatment)

, ACE inhibitors, potassium-sparing diuretics, beta blockers) must be avoided. Cation-exchange resins (eg, sodium polystyrene sulfonate [Kayexalate], alkalinizing salts) can be helpful in controlling hyperkalemia. In many instances, careful evaluation of iatrogenic offenders (eg, beta blockers, ACE inhibitors) can explain persistently high potassium levels in the absence of moderate to severe renal failure. Previous Next: Avoidance and Prevention A variety of drugs can aggravate or cause

2014 eMedicine.com

46. Hyperkalemia (Treatment)

, Collingridge DS, Harmston GE. Fludrocortisone is effective in the management of tacrolimus-induced hyperkalemia in liver transplant recipients. Transplant Proc . 2011 Sep. 43(7):2664-8. . Rogers FB, Li SC. Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: case report and review of the literature. J Trauma . 2001 Aug. 51(2):395-7. . McGowan CE, Saha S, Chu G, Resnick MB, Moss SF. Intestinal necrosis due to sodium polystyrene sulfonate (...) (Kayexalate) in sorbitol. South Med J . 2009 May. 102(5):493-7. . . US Food and Drug Administration. Safety: Kayexalate (sodium polystyrene sulfonate) powder. Available at . Accessed: October 5, 2015. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med . 2013 Mar. 126(3):264.e9-24. . Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, et al. Effect of Patiromer on Serum Potassium Level

2014 eMedicine.com

47. Gastritis, Acute (Overview)

. Note the following: Drugs - NSAIDs, such as aspirin, ibuprofen, and naproxen; cocaine; iron; colchicine, when at toxic levels, as in patients with failing renal or hepatic function; kayexalate; chemotherapeutic agents, such as mitomycin C, 5-fluoro-2-deoxyuridine, and floxuridine Potent alcoholic beverages, such as whisky, vodka, and gin Bacterial infections - H pylori (most frequent), H heilmanii (rare), streptococci (rare), staphylococci (rare), Proteus species (rare), Clostridium species (rare

2014 eMedicine.com

48. Hyperkalemia (Overview)

(Florinef), in patients with hyporeninemia or hypoaldosteronism or solid organ transplant patients with chronic hyperkalemia from calcineurin inhibitor use Potassiuim binders include cation exchange resins such as sodium polystyrene sulfonate (SPS; Kayexalate), patiromer, or sodium zirconium cyclosilicate (Lokelma); an SPS retention enema may be used for hyperkalemic emergencies, oral products have slower onset of action, but may be considered for patients with advanced renal failure who are not yet

2014 eMedicine.com

49. Metabolic Alkalosis (Overview)

with a cation-exchange resin (eg, sodium polystyrene sulfonate [Kayexalate]); the resin binds the cation, leaving bicarbonate unbound. Thiazides and loop diuretics enhance sodium chloride excretion in the distal convoluted tubule and the thick ascending loop, respectively. These agents cause metabolic alkalosis by chloride depletion and by increased delivery of sodium ions to the collecting duct, which enhances potassium ion and hydrogen ion secretion. Volume depletion also stimulates aldosterone secretion

2014 eMedicine.com

50. Hyperkalemia (Follow-up)

, Collingridge DS, Harmston GE. Fludrocortisone is effective in the management of tacrolimus-induced hyperkalemia in liver transplant recipients. Transplant Proc . 2011 Sep. 43(7):2664-8. . Rogers FB, Li SC. Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: case report and review of the literature. J Trauma . 2001 Aug. 51(2):395-7. . McGowan CE, Saha S, Chu G, Resnick MB, Moss SF. Intestinal necrosis due to sodium polystyrene sulfonate (...) (Kayexalate) in sorbitol. South Med J . 2009 May. 102(5):493-7. . . US Food and Drug Administration. Safety: Kayexalate (sodium polystyrene sulfonate) powder. Available at . Accessed: October 5, 2015. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med . 2013 Mar. 126(3):264.e9-24. . Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, et al. Effect of Patiromer on Serum Potassium Level

2014 eMedicine.com

51. Hyperchloremic Acidosis (Follow-up)

, ACE inhibitors, potassium-sparing diuretics, beta blockers) must be avoided. Cation-exchange resins (eg, sodium polystyrene sulfonate [Kayexalate], alkalinizing salts) can be helpful in controlling hyperkalemia. In many instances, careful evaluation of iatrogenic offenders (eg, beta blockers, ACE inhibitors) can explain persistently high potassium levels in the absence of moderate to severe renal failure. Previous Next: Avoidance and Prevention A variety of drugs can aggravate or cause

2014 eMedicine.com

52. Uremia (Follow-up)

to stabilize cardiac membranes, bicarbonate, insulin and glucose administration, or inhaled or intravenous beta agonists. Nonemergent hyperkalemia can be treated with oral potassium binders (eg, sodium polystyrene sulfonate [Kayexalate]). Correction of acidemia may improve the potassium balance. In addition, it is imperative to discontinue any medicine that might be contributing to the hyperkalemia, including the following: Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-receptor blockers (ARBs

2014 eMedicine.com

53. Hypokalemia (Diagnosis)

Tools Most Popular Articles According to Nephrologists Recommended 2002 907757-overview Diseases & Conditions Diseases & Conditions 2010 sps-kayexalate-sodium-polystyrene-sulfonate-342837 Drugs Drugs 2010 voreloxin-999310 Drugs Drugs 2002 921382-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine Pediatrics

54. Acute Myelocytic Leukemia (Treatment)

organomegaly, are at risk for severe, often life-threatening metabolic derangements. Before beginning cytoreduction, correct any existing abnormalities and take measures to prevent new ones. Hyperkalemia and hyperphosphatemia with associated hypocalcemia result from rapid cell turnover and destruction. Promptly treat elevated potassium levels by using measures such as sodium polystyrene sulfonate (Kayexalate), an insulin and glucose combination, and, sometimes, hemodialysis. Calcium replacement is often

2014 eMedicine Pediatrics

55. Oliguria (Follow-up)

. Serum potassium levels of 5.5-6.5 mEq/L should be treated by eliminating all sources of potassium from the diet or IV fluids and administration of a cation exchange resin, such as sodium polystyrene sulfonate (Kayexalate). Kayexalate requires several hours of contact with the colonic mucosa to be effective, and the rectal route of administration is preferred. Complications of this therapy include hypernatremia and constipation. Emergency treatment of hyperkalemia is indicated when serum potassium (...) exceeds 6.5mEq/L or if peaked T waves are present. In addition to Kayexalate, patients should receive calcium gluconate (with continuous electrocardiographic monitoring) to counteract the effects of hyperkalemia on the myocardium. Uptake of potassium by cells can be stimulated by infusion of glucose and insulin or by beta-agonists (albuterol by nebulizer). The efficacy and convenience of nebulized albuterol has been well described in hemodialysis patients with hyperkalemia, but it can cause

2014 eMedicine Pediatrics

56. Hypokalemia (Follow-up)

& Conditions Diseases & Conditions 2010 sps-kayexalate-sodium-polystyrene-sulfonate-342837 Drugs Drugs 2010 voreloxin-999310 Drugs Drugs 2002 921382-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine Pediatrics

57. Acute Myelocytic Leukemia (Follow-up)

organomegaly, are at risk for severe, often life-threatening metabolic derangements. Before beginning cytoreduction, correct any existing abnormalities and take measures to prevent new ones. Hyperkalemia and hyperphosphatemia with associated hypocalcemia result from rapid cell turnover and destruction. Promptly treat elevated potassium levels by using measures such as sodium polystyrene sulfonate (Kayexalate), an insulin and glucose combination, and, sometimes, hemodialysis. Calcium replacement is often

2014 eMedicine Pediatrics

58. Acute Tubular Necrosis (Follow-up)

such as sodium polystyrene sulfonate (Kayexalate). Kayexalate requires several hours of contact with the colonic mucosa to be effective; the rectal route of administration is preferred. Complications of this therapy include hypernatremia and constipation. An attempt can be made to lower serum potassium concentration by increasing the dose of diuretics in those patients responding to them. When serum potassium exceeds 6.5 mEq/L or tall peaked T waves are evident on the ECG, emergency treatment of hyperkalemia (...) is indicated. In addition to Kayexalate, administer intravenous sodium bicarbonate, which causes a rapid shift of potassium into cells. The magnitude of the potassium intracellular shift is variable, and thus, bicarbonate is not reliable in lowering the potassium level. Such therapy should be used with caution because it can precipitate hypocalcemia and sodium overload. Sodium bicarbonate uptake of potassium by cells can also be stimulated by infusion of glucose and insulin or by beta agonists (albuterol

2014 eMedicine Pediatrics

59. Fluid, Electrolyte, and Nutrition Management of the Newborn (Treatment)

to enhance potassium excretion, including IV furosemide 1mg/kg or rectally administered sodium polystyrene sulfonate (Kayexalate) 1g/kg (do not use sorbitol-containing products and do not administer orally). Several hours must pass before any effect is observed with either of these medications. Dialysis or exchange transfusion may be used to assist in more rapidly removing potassium from the body. Hypercalcemia and hypocalcemia Total serum calcium levels in term infants decline from values of 10-11mg/dL

2014 eMedicine Pediatrics

60. Extremely Low Birth Weight Infant (Treatment)

to the extracellular compartment following delivery. [ ] Normal potassium concentration is recovered in 4–5 days, with an eventual increase in glomerular filtration rate and increased diuresis. However, nonoliguric hyperkalemia has been associated with cardiac arrhythmias and death. [ ] There is no current guideline for the most effective treatment of hyperkalemia in ELBW infants; suggested therapies include insulin with glucose, albuterol inhalation, calcium, diuresis with furosemide, kayexalate and, rarely

2014 eMedicine Pediatrics

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