sodium polystyrene sulfonate

sodium

 [so´de-um]

a chemical element, atomic number 11, atomic weight 22.990, symbol Na. (See Appendix 6.) Sodium is the major cation of the extracellular fluid, constituting 90 to 95 per cent of all cations in the blood plasma and interstitial fluid; it thus determines the osmolality of the extracellular fluid. The serum sodium concentration is normally about 140 mEq/L. If the sodium level and osmolality fall, osmoreceptors in the hypothalamus are stimulated and cause the release of antidiuretic hormone from the posterior lobe of the pituitary gland. This hormone increases the absorption of water in the collecting ducts of the kidneys so that water is conserved while sodium and other electrolytes are excreted in the urine. If the sodium level and osmolality rise, neurons in the thirst center of the hypothalamus are stimulated. The thirsty person then drinks enough water to restore the osmolality of the extracellular fluid to the normal level.



A decrease in the serum sodium concentration (hyponatremia) can occur in a variety of conditions. It is often associated with deficient fluid volume due to diarrhea or vomiting when water is replaced faster than sodium. It can also occur in syndrome of inappropriate antidiuretic hormone, in the late stages of congestive heart failure or cirrhosis of the liver, in acute or chronic renal failure, and in diuretic therapy. An increase in the serum sodium concentration (hypernatremia) occurs when insensible water loss is not replaced by drinking, as in a comatose patient with diabetes insipidus.

sodium acetate a source of sodium ions for hemodialysis and peritoneal dialysis, as well as a systemic and urinary alkalizer.

sodium ascorbate an antiscorbutic vitamin and nutritional supplement for parenteral administration. It is also used as an aid to deferoxamine therapy in the treatment of chronic iron toxicity.

sodium benzoate an antifungal agent also used in a test of liver function.

sodium bicarbonate NaHCO₃, a white powder commonly found in households. It has a wide variety of uses in chemistry, in pharmaceuticals, and in consumer products. It is sometimes taken in water as a remedy for acid indigestion but should not be used regularly since when taken in excess it tends to cause alkalosis. It can be mixed with water and applied as a paste for relief of pain in treatment of minor burns and insect bites and stings. A cupful in the bath water may help relieve itching caused by an allergic reaction. Called also baking soda and bicarbonate of soda.

sodium biphosphate monobasic sodium phosphate.

sodium carbonate a compound now used primarily as an alkalizing agent in pharmaceuticals; it has been used as a lotion or bath in the treatment of scaly skin, and as a detergent.

sodium chloride common table salt, a necessary constituent of the body and therefore of the diet, involved in maintaining osmotic tension of blood and tissues; uses include replenishment of electrolytes in the body, irrigation of wounds and body cavities, enema, inhaled mucolytic, topical osmotic ophthalmic agent, and preparation of pharmaceuticals. Called also salt.

sodium citrate a sodium salt of citric acid, used as an anticoagulant for blood or plasma that is to be fractionated or for blood that is to be stored. It is also administered orally as a urinary alkalizer.

dibasic sodium phosphate a salt of phosphoric acid; used alone or in combination with other phosphate compounds, it is given intravenously as an electrolyte replenisher, orally or rectally as a laxative, and orally as a urinary acidifier and for prevention of kidney stones.

sodium ferric gluconate a hematinic used especially in treatment of hemodialysis patients with iron deficiency anemia who are also receiving erythropoietin therapy. Administered by intravenous injection.

sodium fluoride a dental caries preventative used in fluoridation of drinking water or applied topically to teeth. Topical preparations include gels (sodium fluoride and phosphoric acid gel, also called APF gel) and solutions (sodium fluoride and acidulated phosphate topical solution, also called APF solution).

sodium glutamate monosodium glutamate.

sodium hydroxide NaOH, a strongly alkaline and caustic compound; used as an alkalizing agent in pharmaceuticals.

sodium hypochlorite a compound having germicidal, deodorizing, and bleaching properties; used in solution to disinfect utensils, and in diluted form (Dakin's solution) as a local antibacterial.

sodium iodide a compound used as a source of iodine.

sodium lactate a compound used in solution to replenish body fluids and electrolytes.

monobasic sodium phosphate

1. a monosodium salt of phosphoric acid; used in buffer solutions, as a urinary acidifier, as a laxative, and as a source of phosphorus in hypophosphatemia, often in combination with potassium phosphate.

2. a monosodium salt of phosphoric acid; used in buffer solutions. Used alone or in combination with other phosphate compounds, it is given intravenously as an electrolyte replenisher, orally or rectally as a laxative, and orally as a urinary acidifier and for prevention of kidney stones.

sodium monofluorophosphate a dental caries preventative applied topically to the teeth.

sodium nitrite an antidote for cyanide poisoning; also used as a preservative in cured meats and other foods.

sodium nitroprusside an antihypertensive agent used in the treatment of acute congestive heart failure and of hypertensive crisis and to produce controlled hypotension during surgery; also used as a reagent.

sodium phenylbutyrate an agent used as adjunctive treatment to control the hyperammonemia of pediatric urea cycle enzyme disorders.

sodium phosphate any of various compounds of sodium and phosphoric acid; usually specifically dibasic sodium phosphate.

sodium polystyrene sulfonate an ion-exchange resin used for removal of potassium ions in hyperkalemia, administered orally or rectally.

sodium propionate a salt used as an antifungal preservative in foods and pharmaceuticals and as a topical antifungal agent.

sodium salicylate see salicylate.

sodium sulfate a cathartic and laxative.

sodium thiosulfate a compound used intravenously as an antidote for cyanide poisoning, in foot baths for prophylaxis of ringworm, and as a topical antifungal agent for tinea versicolor. Also used in measuring the volume of extracellular body fluid and the renal glomerular filtration rate.

sodium polystyrene sulfonate

Kayexalate, K-Exit Poudre (CA), Kionex, PHL-Sodium Polystyrene Sulfonate (CA), PMS-Sodium Polystyrene Sulfonate (CA), Resonium A (UK), SPS Sodium Polystyrene Sulfonate

Pharmacologic class: Cation exchange resin

Therapeutic class: Potassium-removing resin

Pregnancy risk category C

Action

Exchanges sodium ions for potassium ions in intestine; potassium is then eliminated in feces, which decreases serum potassium level.

Availability

Oral or rectal powder for suspension: 15 g/4 level teaspoons

Suspension: 15 g/60 ml

Indications and dosages

➣ Hyperkalemia

Adults: 15 g P.O. one to four times daily in water or syrup, or 30 to 50 g P.R. q 6 hours; may instill through nasogastric tube as necessary

Contraindications

• Hypersensitivity to drug

• Hypokalemia or other electrolyte imbalances

• Obstructive bowel disease

• Neonates with reduced gut motility; oral administration in neonates

Precautions

Use cautiously in:

• renal or heart failure, severe edema, severe hypertension

• concomitant administration of sorbitol (use not recommended)

• pregnant patients

• children (efficacy not established).

Administration

• Know that drug may take hours to days to lower serum potassium level. Thus, it shouldn't be used alone to treat severe hyperkalemia.

• For rectal use, mix resin in water only; never use mineral oil. Insert #28F rubber tube 20 cm into sigmoid colon, and tape it in place. Or use indwelling urinary catheter with 30-ml balloon inflated distal to anal sphincter. Keep rectal solution at room temperature; swirl gently while administering. After giving dose, flush tubing with approximately 100 ml of sodium-free fluid; then flush rectum to remove drug residue.

• For oral use, position patient carefully to avoid aspiration that may lead to bronchopulmonary complications.

• In elderly patients prone to fecal impaction, give cleansing enema before sodium polystyrene enema.

Adverse reactions

GI: nausea, vomiting, constipation, fecal impaction, gastric irritation, anorexia, intestinal necrosis, other serious GI adverse events (bleeding, ischemic colitis, perforation)

Metabolic: sodium retention, other electrolyte abnormalities, severe hypokalemia

Interactions

Drug-drug. Antacids, laxatives: systemic alkalosis

Drug-diagnostic tests. Calcium, magnesium, potassium: decreased levels

Sodium: increased level

Patient monitoring

☞ Monitor electrolyte levels. Watch for signs and symptoms of electrolyte imbalances, particularly sodium overload and hypokalemia.

☞ Be aware that intestinal necrosis and other serious GI adverse events (bleeding, ischemic colitis, perforation) have occurred with drug use. The majority of cases occurred with concomitant use of sorbitol.

☞ If clinically significant constipation develops, discontinue drug until normal bowel motion resumes. Be aware that magnesium-containing laxatives or sorbitol shouldn't be used to correct constipation.

Patient teaching

• Tell patient drug may cause constipation. Instruct him to report this if it becomes a problem.

• Teach patient about recommended diet (generally, low in sodium and potassium).

• For oral use, instruct patient to mix only with water, or syrup-never with orange juice.

• Advise patient to refrigerate oral solution to improve taste.

☞ Instruct patient to immediately report serious GI problems, including bleeding and abdominal pain, and early signs and symptoms of hypokalemia, including a pattern of irritable confusion and delayed thought processes.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

so·di·um pol·y·sty·rene sul·fo·nate

a cationic exchange resin used in hyperpotassemia.