A Case of Fatal Intestinal Infarct Preceded by Recurrent Ischaemic Colitis due to the Enterotoxic Effect of Sodium Polystyrene Sulfonate

  • Renato De Vecchis Medical and Polyspecialist Centre, Department of Cardiology, DSB 29, S. Gennaro dei Poveri Hospital, Naples, Italy
  • Andrea Paccone Department of Cardiology, Aldo Moro University, Bari, Italy

Keywords

Chronic renal failure, hyperkalaemia, sodium polystyrene sulfonate, iatrogenic ischaemic colitis

Abstract

Case description: A 64-year-old patient with chronic renal failure and persistent hyperkalaemia not corrected by dialysis, was prescribed sodium polystyrene sulfonate (SPS) at a low dose (30 g/day for 2 days a week during the long interdialytic interval). After 3 months of therapy, the patient developed intense abdominal pain with non-specific colitis identified with a colonoscopy. In addition, the biopsy specimens showed rhomboid SPS crystals in the intestinal mucosa. Fourteen months after discontinuing therapy, the patient again presented with colitis and persistent biopsy finding of SPS crystals. The patient died a few months later due to intestinal infarction. 
Discussion and conclusion: SPS is a cation exchange resin used to treat hyperkalaemia resistant to dialysis, but may cause inflammation and ischaemia of the colon. In our patient, a short 3-month course of low-dose SPS therapy (without sorbitol, which is used to counter iatrogenic constipation caused by SPS) induced relapsing colitis, which was followed by massive intestinal infarction a few months later. In light of frequent reports of its enterotoxic effects, SPS should be replaced with the new potassium chelators (patiromer and sodium zirconium cyclosilicate).

VIEW THE ENTIRE ARTICLE

References

  • Hagan AE, Farrington CA, Wall GC, Belz MM. Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study. Clin Nephrol 2016;85(1):38–43.
  • Sterns RH, Rojas M, Bernstein P, Chennupati S. Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? J Am Soc Nephrol 2010;21(5):733–735.
  • Seliger SL. Hyperkalemia in patients with chronic renal failure. Nephrol Dial Transplant 2019;34(Suppl 3):iii12–iii18.
  • Dardik A, Moesinger RC, Efron G, Barbul A, Harrison MG. Acute abdomen with colonic necrosis induced by kayexalate-sorbitol. South Med J 2000;93(5):511–513.
  • Bennett LN, Myers TF, Lambert GH. Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram infant with hyperkalemia. Am J Perinatol 1996;13(3):167–170.
  • Gerstman BB, Kirkman R, Platt R. Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol. Am J Kidney Dis 1992;20(2):159–161.
  • Trottier V, Drolet S, Morcos MW. Ileocolic perforation secondary to sodium polystyrene sulfonate in sorbitol use: a case report. Can J Gastroenterol 2009;23(10):689–690.
  • Nguyen T, Ondrik D, Zhufyak O, To W, He S. Hyperkalemia and potential pitfalls of sodium polystyrene sulfonate. JAAPA 2015;28(3):41–45.
  • Watson M, Abbott KC, Yuan CM. Damned if you do, damned if you don’t: potassium binding resins in hyperkalemia. Clin J Am Soc Nephrol 2010;5(10):1723–1726.
  • Pusztaszeri M, Christodoulou M, Proietti S, Seelentag W. Kayexalate intake (in sorbitol) and jejunal diverticulitis, a causative role or an innocent bystander? Case Rep Gastroenterol 2007;1(1):144–151.
  • Tapia C, Schneider T, Manz M. From hyperkalemia to ischemic colitis: a resinous way. Clin Gastroenterol Hepatol 2009;7(8):e46–47.
  • Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med 2013;126(3):264.e9–24.
  • Bushinsky DA, Williams GH, Pitt B, Weir MR, Freeman MW, Garza D, et al. Patiromer induces rapid and sustained potassium lowering in patients with chronic kidney disease and hyperkalemia. Kidney Int 2015;88(6):1427–1433.
  • Montaperto AG, Gandhi MA, Gashlin LZ, Symoniak MR. Patiromer: a clinical review. Curr Med Res Opin 2016;32(1):155–164.
  • Rafique Z, Peacock WF, LoVecchio F, Levy PD. Sodium zirconium cyclosilicate (ZS-9) for the treatment of hyperkalemia. Expert Opin Pharmacother 2015;16(11):1727–1734.
  • Published: 2021-01-19

    Issue: Vol 8 No 1 (view)

    Section: Articles

    How to cite:
    1.
    De Vecchis R, Paccone A. A Case of Fatal Intestinal Infarct Preceded by Recurrent Ischaemic Colitis due to the Enterotoxic Effect of Sodium Polystyrene Sulfonate . EJCRIM 2021;8 doi:10.12890/2021_001973.