Dose:  1 to 2 gram/kg/dose

Frequency: 1 to 4 times per day

Comments: Sodium polystyrene sulfonate suspension (Kayexalate) is a cation exchange resin used for the reduction of elevated serum potassium. It can be administered  orally or rectally.  The efficiency of this process in the colon is limited and unpredictable. In vitro this can approach 3 mEq, in vivo one gram of Kayexalate resin/kg should lower serum potassium approximately 1 mEq/L. The action of the medication is to slowly release sodium ions from the resin and replace them with potassium ions as the resin passes through the GI tract or is retained in the colon as an enema. The effect is not immediate and takes 2 to 12 hours after oral administration, longer after rectal administration. Further comments on sodium polystyrene sulfonate suspension (Kayexalate) .

Toxicity: Hypokalemia, hypocalcemia, hypomagnesemia, hypernatremia. Oral administration may be associated with gastric irritation, anorexia, and vomiting. Constipation may follow administration by either route (Facts and Comparisons, Inc. Drug Facts and Comparisons. Olin, B.R. ed. St. Louis, MO: Facts and Comparisons, Inc; 1996, page 170f). Hematochezia was seen in 4 of 20 infants who were treated with sodium polystyrene sulfonate enemas for hyperkalemia (J Perinatol 1995; 15:139-42). Hemorrhagic colitis was found at autopsy in one patient who died shortly after administration of the enema. The four were given a formulation mixed in 20% sorbitol. All of the infants with hematochezia were less than 29 weeks gestation and had birth weights less than 1250 grams. The unit dose product has a sorbitol concentration of 14%.

Preparation: Sodium polystyrene sulfonate suspension (Kayexalate) is available in a 1 gram/4 ml concentration. A unit dose preparation is available with 15 grams of sodium polystyrene sulfonate per 60 cc. After shaking bottle well, the suspension may be given directly without dilution. [The old formulation required the mixing of 1 gram of powered resin to be mixed with 5 ml sorbitol (20%) for retention enemas is no longer necessary with the unit dose product.] Stable for 24 hours after opening. Do not heat or refrigerate, administer at body temperature.