Association of Prescription of Oral Sodium Polystyrene Sulfonate With Sorbitol in an Inpatient Setting With Colonic Necrosis: A Retrospective Cohort Study

Watson, Maura A.; Baker, Thomas P.; Nguyen, A. R.; Sebastianelli, Mary E.; Stewart, Heather; Oliver, David K.; Abbott, Kevin C.; Yuan, Christina M.

doi:10.1053/j.ajkd.2012.04.023

Cited by 78 publications

(61 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…50 A similarly low incidence of colonic necrosis was described in another retrospective cohort (0.14%, vs. 0.07% in those not exposed to this drug). 51 Notwithstanding the relative rarity of these severe injuries, the absolute number of patients affected is not trivial, due to the frequency with which sodium polystyrene sulfonate continues to be used. 38 Following a black box warning by the US Food and Drug Administration (FDA) the mixture of sodium-polystyrene sulfonate with 70% sorbitol has been banned, 52 but versions without sorbitol or with sorbitol added at a 33% concentration remain in use.…”

Section: Use Of Potassium Binders For Chronic Management Of Hyperkalementioning

confidence: 99%

Updates in hyperkalemia: Outcomes and therapeutic strategies

Kövesdy

2016

Rev Endocr Metab Disord

View full text Add to dashboard Cite

Hyperkalemia is a frequent clinical abnormality in patients with chronic kidney disease, and it is associated with higher risk of mortality and malignant arrhythmias. Severe hyperkalemia is a medical emergency, which requires immediate therapies, followed by interventions aimed at preventing its recurrence. Current treatment paradigms for chronic hyperkalemia management are focused on eliminating predisposing factors, such as high potassium intake in diets or supplements, and the use of medications known to raise potassium level. Among the latter, inhibitors of the renin-angiotensin aldosterone system are some of the most commonly involved medications, and their discontinuation is often the first step taken by clinicians to prevent the recurrence of hyperkalemia. While this strategy is usually successful, it also deprives patients of the recognized benefits of this class, such as their renoprotective effects. The development of novel potassium binders has ushered in a new era of hyperkalemia management, with a focus on chronic therapy while maintaining the use of beneficial, but hyperkalemia-inducing medications such as renin-angiotensin aldosterone system inhibitors. This review article examines the incidence and clinical consequences of hyperkalemia, and its various treatment options, with special emphasis on novel therapeutic agents and the potential benefits of their application.

show abstract

Section: Use Of Potassium Binders For Chronic Management Of Hyperkalementioning

confidence: 99%

Updates in hyperkalemia: Outcomes and therapeutic strategies

Kövesdy

2016

Rev Endocr Metab Disord

View full text Add to dashboard Cite

show abstract

“…2 Harel et al 2 urge caution in the use of SPS, but others have argued that the common clinical use and the infrequency of complications suggest that SPS is usually well tolerated and effective. 3,82 The concerns about safety and efficacy have prompted interest in developing new agents to treat hyperkalemia. Two have recently been evaluated in prospective trials and seem to be effective.…”

Section: Treatment Of Hyperkalemiamentioning

confidence: 99%

Potassium and Its Discontents

Ellison

Terker

Gamba

2016

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Hyperkalemia is common in patients with impaired kidney function or who take drugs that inhibit the renin-angiotensin-aldosterone axis. During the past decade, substantial advances in understanding how the body controls potassium excretion have been made, which may lead to improved standard of care for these patients. Renal potassium disposition is primarily handled by a short segment of the nephron, comprising part of the distal convoluted tubule and the connecting tubule, and regulation results from the interplay between aldosterone and plasma potassium. When dietary potassium intake and plasma potassium are low, the electroneutral sodium chloride cotransporter is activated, leading to salt retention. This effect limits sodium delivery to potassium secretory segments, limiting potassium losses. In contrast, when dietary potassium intake is high, aldosterone is stimulated. Simultaneously, potassium inhibits the sodium chloride cotransporter. Because more sodium is then delivered to potassium secretory segments, primed by aldosterone, kaliuresis results. When these processes are disrupted, hyperkalemia results. Recently, new agents capable of removing potassium from the body and treating hyperkalemia have been tested in clinical trials. This development suggests that more effective and safer approaches to the prevention and treatment of hyperkalemia may be on the horizon.

show abstract

“…However, the safety of this medication was called into question when reports began to emerge of cases of colonic necrosis [95], and SPS with 70 % sorbitol now carries a black box warning [96]. The estimated incidence of this complication, based on the largest available study, is 0.14 %, with a number needed to harm of 1395 [97]. Another potential adverse effect of SPS is extracellular volume expansion: a 60 g dose of SPS contains 65 mEq of sodium.…”

Section: Potassium: Foe – Deleterious Effects Of Potassium Excessmentioning

confidence: 99%

Potassium: friend or foe?

Rodan

2016

Pediatr Nephrol

View full text Add to dashboard Cite

The kidney plays an essential role in maintaining homeostasis of blood ion concentrations. Because the concentration gradient of potassium across the cell membrane is a key determinant of the membrane potential of cells, even small deviations in serum potassium from the normal setpoint can lead to severe muscle dysfunction, resulting in respiratory failure and cardiac arrest. Less severe hypo- and hyperkalemia are also associated with morbidity and mortality across various patient populations. In addition, deficiencies in potassium intake have been associated with hypertension and adverse cardiovascular and renal outcomes. This is likely due in part to the interrelated handling of sodium and potassium by the kidney. Here, data on the beneficial effects of potassium on blood pressure and cardiovascular and renal outcomes will be reviewed, along with the physiological basis for these effects. In some patient populations, however, potassium excess is deleterious. Risk factors for the development of hyperkalemia will be reviewed, as well as the risks and benefits of existing and emerging therapies for hyperkalemia.

show abstract

Association of Prescription of Oral Sodium Polystyrene Sulfonate With Sorbitol in an Inpatient Setting With Colonic Necrosis: A Retrospective Cohort Study

Cited by 78 publications

References 28 publications

Updates in hyperkalemia: Outcomes and therapeutic strategies

Updates in hyperkalemia: Outcomes and therapeutic strategies

Potassium and Its Discontents

Potassium: friend or foe?

Contact Info

Product

Resources

About