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HWN Suggests

Kayexalate is Really, Most Sincerely Dead

We already knew that SPS was ineffective, and we suspected, based on some very small studies and reports, that it could cause harm. Now we have a population-level study demonstrating that SPS has an extremely robust association with hospitalization for a nasty set of adverse events, driven in large part by a nearly fivefold risk of intestinal ischemia or thrombosis. So the next time it feels like you don't have time to argue against SPS on the merits, print a copy of this excellent study by Dr. Noel and use it as an academic (and if need be, physical) shield to protect your patients from this useless and harmful relic

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  Emergency Medicine Myth #3: Kayexelate in HyperK+, Useless? Harmful?

Save your patient, yourself, and your nurses from dealing with the unpleasant after-effects of SPS (i.e., diarrhea) by avoiding this ineffective and potentially dangerous medication.

Articles of Interest

A Brave New Kayexalate Free World

There may soon come a time when we witness the death of the much maligned cation-exchange resin, Kayexalate Unfortunately not for the reasons we hoped. We will not see the use of sodium polystyrene sulfonate fade from use in the modern Emergency Department because of our tireless efforts to remind our Internal Medicine colleagues of its lack of efficacy. Rather its clinically irrelevant place in the management of acute hyperkalemia will now be replaced by a brand new shiny cation-exchange resin that our Nephrologist consultants can use to delay the 3 am dialysis treatment our patient with a potassium of 9 mmol/L desperately requires.

Be Skeptical… EM Myths and Their Evidence

There actually is no good literature based evidence for the effect of kayexalate on lowering serum potassium.

Elevated Potassium: Let's rethink Kayexalate and other Potassium Binding Agent

· To date, there are no large RCTs examining the efficacy of SPS in patients with acute hyperkalemia. Further, SPS use is not without risk. Administration of SPS has been associated with GI disturbances, significant electrolyte abnormalities and, when given alone or with cathartics, bowel necrosis. The risk of bowel necrosis, in particular, is higher in hemodialysis dependent patients.

Hyperkalemia and Myth of Kayexalate

Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours. Bowel necrosis is a rare adverse event that can occur with Kayexalate.

Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department?

Finally, we have a Cochrane Review (Mahoney 2005) that states that potassium-absorbing resins have never been found to be effective in the first hours of treatment. Alright, so a review of the literature shows that there is virtually no benefit in the emergent setting to the use of kayexalate. But is there a downside? As with all medications, there is. In this case, there is a rare but highly lethal complication of the drug: Colonic Necrosis.

Kayexalate for Acute Hyperkalemia

Although this analysis does not recruit or treat ED patients with potassium levels exceeding 6 mEq/L and/or ECG changes, the implication is that Kayexalate may have limited or no role in the management of hyperkalemia given more effective acute alternatives (dialysis, insulin, inhaled B-agonists). If cathartics are used clinicians should remember that small frequent diarrhea stools excrete more potassium than single large stools either with or without Kayexalate.

Kayexalate for Hyperkalemia Unproven and Ineffective with One Mean Side Effect

The scant literature on this topic was summed up in a Cochrane review in 2005 that stated that potassium-absorbing resins have never been found to be effective in the first hours of treatment. (Cochrane Database Syst Rev 2005; http://bit.ly/1HWfR4W.) A review of the literature shows that there is virtually no benefit in the emergent setting for SPS. But is there a downside? Of course, though we are talking about a rare but highly lethal complication of the drug: colonic necrosis.

Kayexalate in Hyperkalemia – to give or not to give?

Therefore, the next time the consulting or admitting team raises the question of giving kayexalate as an adjunctive therapy for hyperkalemia, consider bringing up its potential for significant harm and the paucity of data on its efficacy in acute hyperkalemia. If the patient is unable excrete potassium effectively through lasix, perhaps it is time for hemodialysis.

Kayexalate, would you like it orally or rectally? - NO THANK YOU!

I really thought this Kayexalate issue had been put to rest few years ago. Why are we so hard to break old habits? This wouldn't be the first time; after all, medical science has had many bloopers when it comes to therapies, things we thought were good for our patients that were later proven to cause harm. Remember Thalidomide, HRT, Xigris..? It is wise to keep an open mind and look for the evidence behind our practice. So, let's see what the literature says about Kayexalate.

No Love, Just Hate with Kayaxylate

Sodium polysterene sulfate (Kayexalate) was once a very popular drug used in the management of hyperkalemia. It is a cation-exchange resin which allows for the exchange of sodium and potassium ions as it moves through the gut. It is usually given with sorbitol to allow for the bowel movement. The onset of action for Kayexalate is reportedly 1-2 hours. The beginning of the end of kayexalate began when there was a proven association with bowel necrosis. There were multiple case reports documenting bowel necrosis with different dosages. A case report from 2009 demonstrated colonic necrosis with a relatively low dose of Kayexalate.

Taking a Second Look at Kayexalate

A review of studies supporting the use of SPS to treat hyperkalemia leaves me wondering why SPS is still used. By today’s standards, the studies supporting the use of SPS for hyperkalemia would be identified as poorly designed case studies, without randomization, without statistical analysis, and without a large sample size.