Kalimate-Induced Upper Gastrointestinal Bleeding in a 77-Year-Old Woman

Wu, Yi‐Hua; Chen, Tsung-Wei; Chou, Jen–Wei

doi:10.1016/j.cgh.2019.05.006

Cited by 4 publications

(6 citation statements)

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“…8 Previous reports have postulated several risk factors for GI adverse events, including CKD, ESRD, solid organ transplantation, immunosuppression, and postoperative status; these factors lead to GI injury associated with Kayexalate or Kalimate treatment by different mechanisms. 5,6,8,[13][14][15][16]21,22 Renal transplant recipients are at increased risk for various adverse events, including infection, graft rejection, and medication adverse effects, in the early post-transplant period. 8 Indeed, many of these risk factors were noted in most cases reviewed in the present study.…”

Section: Gi Bleed (1)mentioning

confidence: 99%

“…Combined histologic, laboratory, clinical and examinations are necessary to eliminate the commonly seen causes of mucosal necrosis and also to correctly diagnose the mucosal necrosis associated with Kayexalate-or Kalimate. 15,18,[20][21][22] However, the observation of Kayexalate or Kalimate angulated crystals with a specific mosaic pattern is critical for diagnosing…”

Section: Gi Bleed (1)mentioning

confidence: 99%

“…The microscopic features of Kalimate crystals and of Kayexalate crystals are the same. 20,22 The colon is the most common site of Kayexalate-or Kalimate-induced GI injuries. Injury caused by Kayexalate may appear in more proximal sections of the GI tract.…”

Section: Authorsmentioning

confidence: 99%

“…28,[51][52][53] However, Kayexalate-or Kalimate-related toxicities in the upper GI tract have been rarely described in the literature. 20,22 Most of these cases do have simultaneous damage to colon. This change may possibly be due to the trend for the use of oral, instead of rectal Kayexalate or Kalimate.…”

Section: Authorsmentioning

confidence: 99%

“…This change may possibly be due to the trend for the use of oral, instead of rectal Kayexalate or Kalimate. 5,[22][23][24][25][26][27][28][51][52][53] However, regardless of the location of Kayexalate or Kalimate-associated injury, mortality remains high. The elevated mortality may be a result of aggravated damage along with the large comorbid disease burden of affected patients.…”

Section: Authorsmentioning

confidence: 99%

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Adverse Gastrointestinal Effects with Kayexalate or Kalimate: A Comprehensive Review

Wu¹,

Chou²,

Lai³

et al. 2021

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Background: Patients with hyperkalemia are commonly treated with Kayexalate or Kalimate. Both drugs are associated with some fatal gastrointestinal (GI) adverse events (AEs). Aim: To assess the clinical characteristics and outcomes of GI AEs induced by Kayexalate or Kalimate from published case reports. Methods: We conducted a systematic review of case reports of Kayexalate or Kalimateinduced GI AEs, from PubMed, Medline, Cochrane Library, Clinical Key, and Google Scholar databases (1948 to March 31, 2020). We analyzed the clinical characteristics, GI AEs, and risk factors of enrolled patients. Results: We identified 41 published articles describing 135 cases of GI AEs induced by Kayexalate (103 cases) or Kalimate (32 cases). The mean age of all patients was 55.5 years. Most patients were male (54.8%). As high as 55.6% preparations were administered with sorbitol whereas 44.4% preparations had no sorbitol. The average time causing GI AEs was 19.8 days. Colon was the most commonly affected site (76.3%). Drug crystals were histopathologically proven in 95.5% of the patients. Meanwhile, mortality was reported in 20.7%. Conclusion: Kayexalate or Kalimate, without or with sorbitol combination, may be related to fatal GI damage. Uremia, hypertension, and transplantation are predisposing factors. Clinicians should be careful in prescribing Kayexalate or Kalimate to patients.

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