KAYEXALATE (SODIUM POLYSTYRENE SULFONATE) IN SORBITOL ASSOCIATED WITHINTESTINAL NECROSIS IN UREMIC PATIENTS

BACKGROUND: Kayexalate (sodium polystyrene sulphonate) in sorbitol is commonly used to treat hyperkalemia in patients with renal insufficien cy. Isolated case reports and one recent large series have documented intestinal necrosis following administration of kayexalate in sorbitol . METHODS: Two patients with luminal kayexalate crystals associated wi th intestinal pathology were first identified in the pathology departm ent, and clinicopathological correlation was carried out. RESULTS: Bot h patients were seriously ill, had prior cardiac surgery and were in r enal failure (uremic). Examination of autopsy and colonic resection sh owed luminal kayexalate crystals associated with underlying mucosal ne crosis, submucosal edema and transmural inflammation. CONCLUSION: Alth ough occurring in complex clinical settings, the pathological findings provide additional evidence that kayexalate in sorbitol may be associ ated with intestinal necrosis and inflammation in uremic patients and that this may be a clinically and pathologically under-recognized iatr ogenic bowel injury.