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Kayexalate

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61. Oliguria (Treatment)

. 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

62. Hyperkalemia (Treatment)

IV Regular insulin and glucose IV Beta-adrenergic agents, such as albuterol (used to manage hyperkalemia with variable results), terbutaline, dobutamine Enhancement of total body potassium elimination This achieved with the following: Sodium polystyrene sulfonate (Kayexalate) orally (PO)/rectally (PR) Furosemide (only if renal function is maintained) Emergent hemodialysis Clinical management Arrhythmias due to hyperkalemia are very difficult to treat with defibrillation, epinephrine (...) , particularly in patients without adequate renal function. Even in patients with severe hyperkalemia and a high gradient, peritoneal dialysis (PD) is not as efficient as hemodialysis in the removal of potassium. Rates of removal with PD are almost equal to the removal rate using sodium polystyrene sulfonate (Kayexalate). Continuous arteriovenous hemofiltration with dialysis (CAVHD) or continuous veno-venous hemofiltration with dialysis (CVVHD) have also been used to remove potassium. However, potassium

2014 eMedicine Pediatrics

63. Hypokalemia (Treatment)

& 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

65. Hypokalemia (Overview)

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

66. Extremely Low Birth Weight Infant (Overview)

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

67. Fluid, Electrolyte, and Nutrition Management of the Newborn (Overview)

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

68. Myopathies (Treatment)

paralysis, attacks are often so brief that no therapy is needed. Note the following: Some patients find that carbohydrate loading at the onset of symptoms may lessen the attack Glucose and insulin may be useful in lowering serum potassium levels. Kayexalate has not been shown to be effective Next: Consultations Consultation with one or more of the following services may be useful: Neurology Rheumatology Infectious disease Previous References Angelini C. Spectrum of metabolic myopathies. Biochim Biophys

2014 eMedicine Emergency Medicine

69. Hyperkalemia (Treatment)

hyperkalemia, for example, may need only excretion enhancement. Some studies are emerging that suggest sodium polystyrene sulfonate (SPS), also known as Kayexalate, may be unhelpful in hyperkalemia and may increase the chance of colonic necrosis (especially when used with sorbitol). [ , , , ] A retrospective study by Lee and Moffett, however, found SPS to be a safe and effective treatment for hyperkalemia in most pediatric patients. However, the investigators suggested that the drug may (...) and effective?. J Am Soc Nephrol . 2010 May. 21(5):733-5. . 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. . Lee J, Moffett BS. Treatment of pediatric hyperkalemia with sodium

2014 eMedicine Emergency Medicine

70. Hyperkalemia (Overview)

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. . Lee J, Moffett BS. Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate. Pediatr Nephrol . 2016 May 23. . Beccari MV, Meaney CJ

2014 eMedicine Emergency Medicine

71. Hyperkalemia (Diagnosis)

(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

72. Fluid, Electrolyte, and Nutrition Management of the Newborn (Follow-up)

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

73. Extremely Low Birth Weight Infant (Follow-up)

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

74. Acute Tubular Necrosis (Treatment)

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

75. Hyperkalemia (Diagnosis)

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. . Lee J, Moffett BS. Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate. Pediatr Nephrol . 2016 May 23. . Beccari MV, Meaney CJ

2014 eMedicine Emergency Medicine

76. Myopathies (Follow-up)

paralysis, attacks are often so brief that no therapy is needed. Note the following: Some patients find that carbohydrate loading at the onset of symptoms may lessen the attack Glucose and insulin may be useful in lowering serum potassium levels. Kayexalate has not been shown to be effective Next: Consultations Consultation with one or more of the following services may be useful: Neurology Rheumatology Infectious disease Previous References Angelini C. Spectrum of metabolic myopathies. Biochim Biophys

2014 eMedicine Emergency Medicine

77. Hyperkalemia (Follow-up)

, Chennupati S. Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective?. J Am Soc Nephrol . 2010 May. 21(5):733-5. . 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

2014 eMedicine Emergency Medicine

78. Timing of Dialysis Initiation: The Billion Dollar Question

can take all these "preventative" medications. I attended conferences where presenters said that they will keep their patients on an ACEi or ARB even till near ESRD by using Kayexalate to prevent hyperkalemia. Try to convince a patient to take kayexalate everyday! Others recommend to stop ACEi or ARB near ESRD to allow for some improvement in eGFR to help affording the patients few extra months off dialysis. Yes, Not every patient is suitable for dialysis and that is something our Nephrology

2011 Renal Fellow Network

79. Sevelamer Crystals in the Gastrointestinal Tract (GIT): A New Entity Associated With Mucosal Injury. (PubMed)

color on hematoxylin and eosin (H&E) staining and violet color on periodic acid-Schiff-alcian special staining with diastase (PAS/D). To validate these findings, sevelamer tablets (Renvela) were crushed and submitted for histologic processing; the findings were identical to those in the patient specimens. The possibility of Kayexalate (sodium polystyrene sulfonate) and cholestyramine had been raised in error. However, Kayexalate has narrow, rectangular "fish scales" and is violet on H&E and magenta (...) on PAS/D; cholestyramine lacks internal "fish scales," is bright orange on H&E, variably gray or hot pink on PAS/D, and is unassociated with mucosal injury. Further study is required to determine whether sevelamer plays a causal role in these injuries; however, its crystal is an important mimic of both Kayexalate and choleystyramine. As the history of sevelamer administration was not documented in any pathology requisition, awareness of sevelamer's characteristic morphology is crucial to avoid

2013 American Journal of Surgical Pathology

80. Study To Evaluate D-Ribose For The Treatment of Congestive Heart Failure

gastrointestinal conditions; currently taking Kayexalate® (sodium polystyrene sulfonate); allergic reaction to Optison™ or Definity® or any of their components. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01858480 Sponsors and Collaborators RiboCor, Inc

2013 Clinical Trials

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