Yes

Antidote

Treatment of hyperkalemia

C

Hypernatremia, hypersensitivity to any component

Use with caution in patients with severe congestive heart failure, hypertension, edema, or renal failure; avoid using the commercially available liquid product in neonates due to the preservative content; large oral doses may cause fecal impaction (especially in elderly); enema will reduce the serum potassium faster than oral administration, but the oral route will result in a greater reduction over several hours.

1% to 10%:

Gastrointestinal: Fecal impaction, constipation, loss of appetite, nausea, vomiting

Symptoms of overdose include hypokalemia including cardiac dysrhythmias, confusion, irritability, EKG changes, muscle weakness, gastrointestinal effects

Treatment is supportive, limited to management of fluid and electrolytes

Systemic alkalosis and seizure has occurred after cation-exchange resins were administered with nonabsorbable cation-donating antacids and laxatives (eg, magnesium hydroxide, aluminum carbonate)

Store prepared suspensions at 15°C to 30°C (59°F to 86°F); store repackaged product in refrigerator and use within 14 days; freshly prepared suspensions should be used within 24 hours; do not heat resin suspension

Removes potassium by exchanging sodium ions for potassium ions in the intestine before the resin is passed from the body; exchange capacity is 1 mEq/g in vivo, and in vitro capacity is 3.1 mEq/g, therefore, a wide range of exchange capacity exists such that close monitoring of serum electrolytes is necessary

Onset of action: Within 2-24 hours

Absorption: Remains in GI tract

Elimination: Completely in feces (primarily as potassium polystyrene sulfonate)

Children:

Oral: 1 g/kg/dose every 6 hours

Rectal: 1 g/kg/dose every 2-6 hours (In small children and infants, employ lower doses by using the practical exchange ratio of 1 mEq K⁺/g of resin as the basis for calculation)

Adults:

Oral: 15 g (60 mL) 1-4 times/day

Rectal: 30-50 g every 6 hours

Do not mix in orange juice

Serum electrolytes (potassium, sodium, calcium, magnesium), EKG

Serum potassium: Adults: 3.5-5.2 mEq/L

Emergency instructions depend on patient's condition. You will be monitored for effects of this medication and frequent blood tests may be necessary. Oral: Take as directed. Mix well with a full glass of liquid (not orange juice). You may experience nausea or vomiting (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or constipation or fecal impaction (increased dietary fluids and exercise may help). Report persistent constipation or gastrointestinal distress; chest pain or rapid heartbeat; or mental confusion or muscle weakness. Pregnancy/breast-feeding precautions: Inform prescriber if pregnant. Consult prescriber if breast-feeding.

Administer oral (or NG) as ~25% sorbitol solution, never mix in orange juice; enema route is less effective than oral administration; retain enema in colon for at least 30-60 minutes and for several hours, if possible; chilling the oral mixture will increase palatability; enema should be followed by irrigation with normal saline to prevent necrosis

Oral or rectal:

Suspension: 1.25 g/5 mL with sorbitol 33% and alcohol 0.3% (60 mL, 120 mL, 200 mL, 500 mL)

Belanger DR, Tierney MG, and Dickinson G, "Effect of Sodium Polystyrene Sulfonate on Lithium Bioavailability," Ann Emerg Med, 1992, 21(11):1312-5.

Haupt HM and Hutchins GM, "Sodium Polystyrene Sulfonate Pneumonitis," Arch Intern Med, 1982, 142(2):379-81.

Malone TA, "Glucose and Insulin Versus Cation-Exchange Resin for the Treatment of Hyperkalemia in Very Low Birth Weight Infants," J Pediatr, 1991, 118(1):121-3.

Tomaszewski C, Musso C, Pearson JR, et al, "Lithium Absorption Prevented by Sodium Polystyrene Sulfonate in Volunteers," Ann Emerg Med, 1992, 21(11):1308-11.