Bowel mucosal necrosis and perforation following administration of calcium polystyrene sulfonate (Kalimate) in patients with hyperkalemia: Report of two cases

Hyperkalemia is a common problem in patients with acute or chronic kidney disease. Cation exchange resins, such as calcium polystyrene sulfonate (Kalimate) or sodium polystyrene sulfonate (Kayexalate), are frequently administered orally or rectally to correct hyperkalemia. Kalimate/Kayexalate administration has been reported to induce gastrointestinal injury. We report two cases of colonic necrosis and bowel perforation following Kalimate adminstration. A review of past literature pertaining to Kalimate/Kayexalate‐associated complications was performed.

[1]  H. Sasano,et al.  Intestinal necrosis related to administration of cation exchange resin without sorbitol: A retrospective analysis of 61 patients with end‐stage renal diseases , 2020, Pathology international.

[2]  Tze-Wah Kao,et al.  Ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose calcium polystyrene sulfonate. , 2015, Journal of the Formosan Medical Association = Taiwan yi zhi.

[3]  A. Tongyoo,et al.  Acute intestinal obstruction due to Kalimate, a potassium-lowering agent: a case report and literature review. , 2013, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[4]  H. Yen,et al.  Calcium polystyrene sulfonate bezoar in the ileum: diagnosis and treatment with double-balloon endoscopy , 2013, Endoscopy.

[5]  C. Alonso-Cotoner,et al.  Colonic necrosis due to calcium polystyrene sulfonate (Kalimate) not suspended in sorbitol. , 2013, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[6]  E. Meaudre,et al.  Intestinal Necrosis Associated with Orally Administered Calcium Polystyrene Sulfonate without Sorbitol , 2011, The Annals of pharmacotherapy.

[7]  M. Joo,et al.  Colonic Mucosal Necrosis Following Administration of Calcium Polystryrene Sulfonate (Kalimate) in a Uremic Patient , 2009, Journal of Korean medical science.

[8]  Tsung-Teh Wu,et al.  Upper Gastrointestinal Tract Injury in Patients Receiving Kayexalate (Sodium Polystyrene Sulfonate) in Sorbitol: Clinical, Endoscopic, and Histopathologic Findings , 2001, The American journal of surgical pathology.

[9]  K. Lillemoe,et al.  Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. , 1987, Surgery.

[10]  F. Zijlstra.  SORBITOL, PROSTAGLANDINS, AND ULCERATIVE COLITIS ENEMAS , 1981, The Lancet.