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Kayexalate

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61. 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

62. 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

63. 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

64. 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

65. 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

66. 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

67. 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

68. Fluid, Electrolyte, and Nutrition Management of the Newborn (Diagnosis)

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

69. 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

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. 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

72. Safety and Efficacy of Sodium Polystyrene Sulfonate in Hyperkalemia

leukocytosis or thrombocytosis. Subjects treated with lactulose, Xifaxan or other non-absorbed antibiotics for hyperammonemia within the last 7 days. Subjects treated with resins (such as Sevelamer acetate), calcium acetate, calcium carbonate, or lanthanum carbonate, within the last 7 days. Subjects treated with Sodium Polystyrene Sulfonate (SPS; e.g. Kayexalate®) or ZS (microporous, fractionated, protonated zirconium silicate) within the last 30 days. Subjects with a life expectancy of less than 3 months

2013 Clinical Trials

73. 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

74. EPLErenone in CsA-Treated Recipients (EpleCsAT): Safety

available for: Arms and Interventions Go to Arm Intervention/treatment Experimental: A Eplerenone Drug: Eplerenone Outcome Measures Go to Primary Outcome Measures : Occurence of an adverse event requiring the discontinuation of eplerenone [ Time Frame: 8 weeks ] Occurrence of an adverse event requiring the discontinuation of eplerenone: serum potassium higher than or equal to 6mmol/L and/or higher than or equal to 5.5mmol/L under 2 measuring spoons of KAYEXALATE® acidosis evidenced by serum alkaline (...) Criteria: All the patients that will be included in this trial have to fulfil no one of the following conditions: serum potassium higher than or equal to 5mmol/L at the date of inclusion one or more history of severe hyperkalemia (serum potassium higher than or equal to 6mmol/L) whatever the reason currently under potassium exchange resin treatment like KAYEXALATE® an acute rejection of the graft within the 6 months before the date of inclusion an ongoing pregnancy or a lack of effective contraception

2013 Clinical Trials

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

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

76. Management of life-threatening hyperkalemia

Dodge 1953). You will notice that sodium polystyrene sulfonate (kayexalate) is not included in this treatment plan. The evidence for SPS is extremely poor, but if it has any effect in acute hyperkalemia, that effect is not for many hours and comes with extra risk (colonic necrosis) that is not clearly outweighed by benefit. I never use SPS in the emergency department. Does sodium bicarbonate work? The bicarb bottom line: We really don’t know. The best guess currently is it may be marginally

2016 First10EM

77. Safety & Efficacy of Zirconium Silicate in Mild to Moderate Hyperkalemia

(such as Sevelamer acetate or Sodium polystyrene sulfonate [SPS; e.g. Kayexalate®]), calcium acetate, calcium carbonate, or lanthanum carbonate, within the last 7 days. Subjects with a life expectancy of less than 3 months. Subjects who are HIV positive. Subjects who are severely physically or mentally incapacitated and who in the opinion of investigator are unable to perform the subjects' tasks associated with the protocol. Women who are pregnant, lactating, or planning to become pregnant. Subjects

2012 Clinical Trials

78. NephMadness 2014 Part 7 - Electrolyte Bracket

NephMadness 2014 Part 7 - Electrolyte Bracket Renal Fellow Network: NephMadness 2014 Part 7 - Electrolyte Bracket | | | | | Sunday, March 23, 2014 NephMadness 2014 Part 7 - Electrolyte Bracket The electrolyte bracket contains a mixture of the old staples of nephrology mixed with some new kids on the block trying to muscle in on established territory, Vaptans vs hypertonic saline and ZS-9 vs Kayexalate. Hypertonic saline is well established and works when used correctly. In my experience

2014 Renal Fellow Network

79. Top nephrology-related stories of 2014

buster" drug for hyperkalemia. The company ZS Pharma reported the results of 2 trials, the trial in JAMA and a phase 3 trial in . Both these studies showed efficient potassium lowering versus placebo and rebound once the drug is discontinued. hosted a lively twitter discussion about the HARMONIZE trial. Concerns for how ZS-9 will be tolerated long term and why it was compared to placebo and not kayexalate or diet. Also, in the high dose group more patients had peripheral edema. ZS-9 has the potential

2014 Renal Fellow Network

80. Top nephrology-related stories of 2013

of a better potassium binder for treating hyperkalemia. This is a frequently encountered problem with life threatening implications. Sodium polystyrene sulphonate (kayexalate) has been put as of late. Many have been calling into question its effectiveness and potential risks (bowel necrosis). For another view on SPS check out at PBFluids. The company presented results from a phase II clinical trial and demonstrated that ZS-9 was capable of lowering potassium with minimal side effects. This could be a huge

2013 Renal Fellow Network

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