Kayexalate (sodium polystyrene sulphonate) in sorbitol associated with intestinal necrosis in uremic patients
Kayexalate (sodium polystyrene sulphonate) in sorbitol
is commonly used to treat hyperkalemia in patients with
renal insufficiency. Isolated case reports and one recent
large series have documented intestinal necrosis following
administration of kayexalate in sorbitol.
METHODS: Two patients with luminal kayexalate
crystals associated with intestinal pathology were first
identified in the pathology department, and clinicopathological
correlation was carried out.
RESULTS: Both patients were seriously ill, had
prior cardiac surgery and were in renal failure (uremic).
Examination of autopsy and colonic resection showed
luminal kayexalate crystals associated with underlying
mucosal necrosis, submucosal edema and transmural inflammation.
CONCLUSION: Although occurring in complex clinical
settings, the pathological findings provide additional
evidence that kayexalate in sorbitol may be associated
with intestinal necrosis and inflammation in uremic
patients and that this may be a clinically and pathologically
under-recognized iatrogenic bowel injury.