Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

Dantas, Eduardo; Coelho, Mariana; Sequeira, Cristiana; Santos, Inês; Martins, Cláudio; Cardoso, Cláudia; Freire, Ricardo; Oliveira, Ana Paula

doi:10.14309/crj.0000000000000585

Cited by 4 publications

(1 citation statement)

References 17 publications

(22 reference statements)

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“…On average, the measured reduction in potassium was 0.99 mEq/dL 10 hours after administration of SPS [ 10 ]. The onset of action is inconsistent and varies from one hour to a day, making its use unfavorable in acute settings [ 11 ].…”

Section: Reviewmentioning

confidence: 99%

Hyperkalemia: Pharmacotherapies and Clinical Considerations

Sinnathamby,

Banh,

Barham

et al. 2024

Cureus

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Hyperkalemia has been defined as a condition where a serum potassium level is >5.5 mmol/l. It is associated with fatal dysrhythmias and muscular dysfunction. Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia. Many of the signs of hyperkalemia are nonspecific. A history and physical examination can be beneficial in the diagnosis of the condition. In this regard, certain characteristic electrocardiogram findings are associated with hyperkalemia along with laboratory potassium levels. In acute and potentially lethal conditions, hyperkalemia treatments include glucose and insulin, bicarbonate, calcium gluconate, beta-2 agonists, hyperventilation, and dialysis. There are several drugs, both old and new, that can additionally aid in the reduction of serum potassium levels. The present investigation evaluated some of these different drugs, including sodium polystyrene sulfonate (SPS), sodium zirconium cyclosilicate (SZC), and patiromer. These drugs each have increased selectivity for potassium and work primarily in the gastrointestinal (GI) tract. Each of these medications has unique benefits and contraindications. Clinicians must be aware of these medications when managing patients with hyperkalemia.

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Section: Reviewmentioning

confidence: 99%

Hyperkalemia: Pharmacotherapies and Clinical Considerations

Sinnathamby,

Banh,

Barham

et al. 2024

Cureus

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Comprehensive analysis of sodium polystyrene sulfonate-induced colitis: A systematic review

Aver,

Ribeiro,

Ballotin

et al. 2023

World J Meta-Anal

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BACKGROUND Sodium polystyrene sulfonate (SPS) is commonly prescribed for the management of hyperkalemia, a critical electrolyte imbalance contributing to over 800000 annual visits to emergency departments. AIM To conduct a systematic review of documented cases of SPS-induced colitis and assess its associated prognosis. METHODS Following the PRISMA-P guidelines, our study employed Medical Subject Headings and Health Sciences Descriptors, skillfully combined using Boolean operators, to conduct comprehensive searches across various electronic databases, including Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Language criteria were confined to English, Spanish, and Portuguese, with no limitations on the publication date. Additionally, we manually scrutinized the reference lists of retrieved studies. To present our findings, we utilized simple descriptive analysis. RESULTS Our search strategy yielded a total of 442 references. After rigorous evaluation, we included 51 references, encompassing 59 documented cases of colitis. Predominant clinical presentations included abdominal pain, observed in 35 (60.3%) cases, and bloating, reported in 18 (31%) cases. The most frequently affected sites of inflammation were the cecum, rectum, and small intestine, accounting for 31%, 25.8%, and 22.4% of cases, respectively. Colonoscopy findings were described in 28 (48.2%) cases, and 29 (50%) of patients required surgical intervention. Among the subset of patients for whom outcome data was available, 39 (67.2%) experienced favorable outcomes, while 12 (20.6%) unfortunately succumbed to the condition. The mean time required for resolution was 36.7 d, with a range spanning from 1 to 120 d. CONCLUSION SPS demonstrates the capacity to effectively lower serum potassium levels within 24 h. However, this benefit is not without the risk of bowel injury. Our study highlights the absence of high-quality data pertaining to the incidence of adverse events associated with SPS usage, making it challenging to determine whether the potential risks outweigh the benefits. However, a significant mortality rate related to SPS-induced colitis was noted. Future investigations should prioritize randomized controlled trials with a sufficiently large patient cohort to ascertain the true utility and safety profile of this medication.

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Intestinal perforation secondary to the use of sodium polystyrene sulfonate, case report

Adriano-Castro,

Sancho-Muriel,

Cholewa

et al. 2024

EJMCR

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Background: The use of cation exchange resins such as sodium polystyrene sulfonate (SPS) in the treatment of hyperkalemia has been associated with potential damage to the gastrointestinal tract. Case Description: We present a clinical case of a 63-year-old male patient admitted following a single-lung transplant who presented a complex postoperative period associating renal failure and hyperkalemia, therefore administering SPS. 17 days afterward, the patient presented a clinical exacerbation with acute abdominal pain, due to a sigmoid perforation. The patient underwent urgent surgery, performing an open sigmoidectomy and terminal colostomy. The anatomo-pathological study of the surgical specimen revealed abundant SPS crystals in the depth of the colonic wall. Conclusions: Close patient surveillance and a high clinical suspicion are essential to prevent potentially fatal complications from the use of SPS. Due to low incidence of this complication, the evidence in literature is limited to case reports and retrospective studies.

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Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

Cited by 4 publications

References 17 publications

Hyperkalemia: Pharmacotherapies and Clinical Considerations

Hyperkalemia: Pharmacotherapies and Clinical Considerations

Comprehensive analysis of sodium polystyrene sulfonate-induced colitis: A systematic review

Intestinal perforation secondary to the use of sodium polystyrene sulfonate, case report

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