SPS

sodium polystyrene sulfonate

(soe-dee-um po-lee-stye-reen sul-fon-ate) ,

Kalexate

(trade name),

Kayexalate

(trade name),

K-Exit

(trade name),

Kionex

(trade name),

SPS

(trade name)

Classification

Therapeutic: hypokalemic
Pharmacologic: cationic exchange resins

Pregnancy Category: C

Indications

Mild to moderate hyperkalemia (if severe, more immediate measures such as sodium bicarbonate IV, calcium, or glucose/insulin infusion should be instituted).

Action

Exchanges sodium ions for potassium ions in the intestine (each 1 g is exchanged for 1 mEq potassium).

Therapeutic effects

Reduction of serum potassium levels.

Pharmacokinetics

Absorption: Distributed throughout the intestine but is nonabsorbable.

Distribution: Not distributed.

Metabolism and Excretion: Eliminated in the feces.

Half-life: Unknown.

Time/action profile (decrease in serum potassium)

ROUTE	ONSET	PEAK	DURATION
PO	2–12 hr	unknown	6–24 hr
Rectal	2–12 hr	unknown	4–6 hr

Contraindications/Precautions

Contraindicated in: Life-threatening hyperkalemia (other, more immediate measures should be instituted);Hypersensitivity to saccharin or parabens (some products);Ileus;Abnormal bowel function (↑ risk for intestinal necrosis);Postoperative patients with no bowel movement (↑ risk for intestinal necrosis);History of impaction, chronic constipation, inflammatory bowel disease, ischemic colitis, vascular intestinal atherosclerosis, previous bowel resection, or bowel obstruction (↑ risk for intestinal necrosis);Known alcohol intolerance (suspension only).

Use Cautiously in: Geriatric: Geriatric patients;Heart failure;Hypertension;Edema;Sodium restriction;Constipation.

Adverse Reactions/Side Effects

Gastrointestinal

• intestinal necrosis (life-threatening)
• constipation (most frequent)
• fecal impaction (most frequent)
• anorexia
• gastric irritation
• ischemic colitis
• nausea
• vomiting

Fluid and Electrolyte

• hypocalcemia
• hypokalemia
• sodium retention
• hypomagnesemia

Interactions

Drug-Drug interaction

Administration with calcium or magnesium-containing antacids may ↓ resin-exchanging ability and ↑ risk of systemic alkalosis.Hypokalemia may enhance digoxin toxicity.Use with sorbitol may ↑ risk of colonic necrosis (concomitant use not recommended).

Route/Dosage

4 level tsp = 15 g (4.1 mEq sodium/g)

Oral (Adults) 15 g 1–4 times daily in water (up to 40 g 4 times daily).

Rectal (Adults) 30–50 g as a retention enema; repeat as needed q 6 hr.

Oral Rectal (Children) 1 g/kg/dose q 6 hr.

Availability (generic available)

Suspension: 15 g sodium polystyrene sulfonate with 20 g sorbitol/60 mL, 15 g sodium polystyrene sulfonate with 14.1 g sorbitol/60 mL

Powder: 15 g/4 level tsp

Nursing implications

Nursing assessment

• Monitor response of symptoms of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QT segments, widened QRS complexes, loss of P waves, and cardiac arrhythmias). Assess for development of hypokalemia (weakness, fatigue, arrhythmias, flat or inverted T waves, prominent U waves).
• Monitor intake and output ratios and daily weight. Assess for symptoms of fluid overload (dyspnea, rales/crackles, jugular venous distention, peripheral edema). Concurrent low-sodium diet may be ordered for patients with HF (see ).
• In patients receiving concurrent digoxin, assess for symptoms of digoxin toxicity (anorexia, nausea, vomiting, visual disturbances, arrhythmias).
• Assess abdomen and note character and frequency of stools. Discontinue sodium polystyrene sulfonate if patient becomes constipated. Concurrent sorbitol or laxatives may be ordered to prevent constipation or impaction. Some products contain sorbitol to prevent constipation. Patient should ideally have 1–2 watery stools each day during therapy. Monitor for intestinal necrosis if sorbitol is added.
• Lab Test Considerations: Monitor serum potassium daily during therapy. Notify health care professional when potassium ↓ to 4–5 mEq/L.
  • Monitor renal function and electrolytes (especially sodium, calcium, bicarbonate, and magnesium) prior to and periodically throughout therapy.

Potential Nursing Diagnoses

Constipation (Side Effects)

Implementation

• Solution is stable for 24 hr when refrigerated.
  • Consult health care professional regarding discontinuation of medications that may increase serum potassium (angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, potassium supplements, salt substitutes).
• An osmotic laxative (sorbitol) is usually administered concurrently to prevent constipation.
• Oral: For oral administration, shake commercially available suspension well before use. When using powder, add prescribed amount to 3–4 mL water/g of powder. Shake well. Syrup may be ordered to improve palatability. Resin cookie or candy recipes are available; discuss with pharmacist or dietitian.
• Retention Enema: Precede retention enema with cleansing enema. Administer solution via rectal tube or 28-French Foley catheter with 30-mL balloon. Insert tube at least 20 cm and tape in place.
  • For retention enema, add powder to 100 mL of prescribed solution (usually sorbitol or 20% dextrose in water). Shake well to dissolve powder thoroughly; should be of liquid consistency. Position patient on left side and elevate hips on pillow if solution begins to leak. Follow administration of medication with additional 50–100 mL of diluent to ensure administration of complete dose. Encourage patient to retain enema as long as possible, at least 30–60 min.
  • After retention period, irrigate colon with 1–2 L of non–sodium-containing solution. Y-connector with tubing may be attached to Foley or rectal tube; cleansing solution is administered through 1 port of the Y and allowed to drain by gravity through the other port.

Patient/Family Teaching

• Explain purpose and method of administration of medication to patient.
• Advise patient to avoid taking antacids or laxatives during therapy, unless approved by health care professional; may cause systemic alkalosis.
• Advise female patient to notify health care professional if pregnant or breast feeding.
• Inform patient of need for frequent lab tests to monitor effectiveness.

Evaluation/Desired Outcomes

• Normalization of serum potassium levels.

SPS

Abbreviation for:
semipermeable surface
simple partial seizure
simulated patient surgery, see there
slow potential shift
Social Phobia Scale
specialised services, see there 
standard payroll system
standard population sample
Suicide Probability Scale
superior petrosal sinus
surgical pathology staging
systemic progressive sclerosis

SPS

Abbreviation for sodium polyanethole sulfonate.

sodium

(sod'e-um) [ soda + -ium (1)] Na

An inorganic metallic element, atomic weight (mass) 22.98987, atomic number 11, specific gravity 0.971. Sodium constitutes about 0.15% of body mass. It is the most abundant cation in extracellular fluids, the main contributor to osmotic pressure and hydration, participates in many specialized pumps and receptors on cell membranes, and plays a fundamental part in the electrical activities of the body, e.g., nerve impulse transmission and muscular contraction.

CAS # 7440-23-5

The normal sodium level in serum is 135 to 145 mmol/L. A decreased level of sodium in the serum is called hyponatremia, an increased level, hypernatremia. These conditions per se are not usually excesses or deficiencies of sodium but rather disturbances in the body's regulation of water, i.e., a change in measured sodium concentrations usually results from water retention or water depletion and not from too little or too much sodium in the body. Synonym: natrium See: hypernatremia; hyponatremia

sodium acetate

C₂H₃NaO₂, a chemical compound used to alkalize urine and kidney dialysis solutions. It is also used as a component in many laboratory reagents, e.g., buffers.

CAS # 127-09-3

Synonym: sodium ethanoate

sodium alginate

NaC₆H₇O₆, a purified carbohydrate product extracted from certain species of seaweed. It is used as a food additive and as a pharmaceutical aid.

sodium ascorbate

C₆H₇NaO₆, the sodium salt of ascorbic acid (vitamin C). It may be used in a sterile solution when parenteral administration of vitamin C is required.

CAS # 134-03-2

sodium benzoate

C₇H₅O₂Na, a white, odorless powder with sweet taste, used as a food preservative.

CAS # 532-32-1

sodium bicarbonate

NaHCO₃, a white odorless powder with a salty taste. It is incompatible with acids, acid salts, ammonium chloride, lime water, ephedrine hydrochloride, and iron chloride. It is used to treat acidosis, e.g., in renal failure. It is used orally as an antacid although its effectiveness for this purpose is questionable. Externally, it is used as a mild alkaline wash. It is also used as a component in many laboratory reagents, e.g., buffers, microbiologic media, and control materials. Synonym: baking soda; sodium hydrogen carbonate

CAS # 144-55-8

sodium carbonate

Na₂CO₃, a white crystalline alkaline powder. It is used in industry to manufacture glass, ceramics, soaps, paper, and sodium salts. Synonym: soda ashwashing soda

CAS # 497-19-8

carboxymethylcellulose sodium

, carboxymethyl sodium cellulose, carboxymethyl cellulose sodium, sodium carboxymethyl cellulose

C₆H₉OCH₂COONa, a white powder used as a pharmaceutical aid and a food additive.

CAS # 9085-26-1

sodium chloride

NaCl, a naturally occurring white crystalline compound; common table salt. It is used in preparation of normal saline solution, as an emetic, and to add flavor to foods. It is incompatible with silver nitrate. In aqueous solution, sodium chloride, a neutral salt, is a strong electrolyte, being almost completely ionized. The sodium and chlorine ions are important in maintaining the proper electrolyte balance in body fluids. The kidneys regulate retention or excretion of sodium chloride in urine; aldosterone directly increases the renal reabsorption of sodium ions. Synonym: salt (1); table salt

CAS # 7647-14-5

sodium citrate

C₆H₅Na₃O₇, a white granular powder soluble in water. It is used as an anticoagulant for blood collected for laboratory analysis or used for transfusion.

CAS # 18996-35-5

sodium ethanoate

Sodium acetate.

sodium fluoride

NaF, a white, poisonous crystalline powder with a salty taste. Minute amounts of sodium fluoride are added to drinking water for fluoridation, in tooth pastes, and in oral rinses (mouth washes) to prevent dental caries (tooth decay). It is also an effective, inexpensive treatment for osteoporosis. See: fluoridation; sodium fluoride poisoning

CAS # 7681-49-4

sodium hydrogen carbonate

Sodium bicarbonate.

sodium hydroxide

NaOH, a whitish solid, soluble in water and making a clear solution. It is an antacid and a caustic. It is used in laundry detergents and in commercial compounds to clean sink traps, toilets, and in the preparation of soap. It is also used as a component in any laboratory reagent that needs pH balancing. Synonym: caustic soda

CAS # 1310-73-2

CAUTION!

It is corrosive. People who handle sodium hydroxide should protect their eyes, mucus membranes, and skin from direct contact.

sodium hypochlorite

NaOCl, an unstable salt used in solution as an antiseptic, disinfectant, and bleaching agent (household bleach).

CAS # 7681-52-9

sodium iodide

NaI, a colorless crystalline solid used as an expectorant.

sodium lactate

C₃H₅NaO₃, a sodium salt of inactive lactic acid. it is used intravenously in one-sixth or one-fourth molar solution to control electrolyte disturbances, esp. acidosis.

sodium lauryl sulfate

C₁₂H₂₅NaO₄S, an anionic surface-active agent used as a pharmaceutical acid.

sodium monofluoroacetate

FCH₂CO₂Na, a toxic pesticide, once banned in the U.S., that inhibits cellular metabolism, esp. in the most metabolically active organs, i.e., the brain and heart. In humans it causes arrhythmias, seizures, coma, and occasionally death. It is used commercially to kill rodents and large animals.

CAS # 62-74-8

sodium monofluorophosphate

Abbreviation: MFP

Na₂PO₃F, a compound used in toothpastes to prevent dental caries (tooth decay)

CAS # 10163-15-2

sodium morrhuate

, morrhuate sodium

The sodium salt of the fatty acids, found in cod liver oil. It is used as a sclerosing agent for the obliteration of varicose veins, including esophageal varices.

sodium nitrite

NaNO₂, a white crystalline powder used as an antidote for cyanide poisoning.

CAS # 7632-00-0

sodium nitroprusside

Abbreviation: SNP

C₅FeN₆Na₂O, an antihypertensive and powerful vasodilator used when rapid reduction in blood pressure is required.

CAUTION!

Infusion of SNP at the maximum dose rate of 10 µg/kg/min should never last for more than 10 min. For treatment of overdose, See: cyanide poisoning

sodium phosphate, dibasic

Na₂HPO₄, the secondary phosphate of sodium, used as a cathartic.

sodium phosphate P 32

A radiopharmaceutical made with radioactive phosphorus (³²P), used in solution to treat polycythemia vera and certain cancers.

sodium polyanethol sulfonate

Abbreviation: SPS

A polyanionic detergent and antimicrobial agent used in microbiological assays to enhance recovery of bacteria.

CAS # 63589-56-0

sodium polystyrene sulfonate

A cation-exchange resin used to remove potassium from the body.

CAS # 28210-41-5

sodium propionate

C₃H₅NaO₂, a crystalline salt used as an antifungal food additive.

CAS # 137-40-6

sodium salicylate

C₇H₅NaO₃, a white crystalline substance with a disagreeable, even nauseating, taste, used to reduce pain and temperature.

CAS # 54-21-7

See: acetylsalicylic acid

sodium sulfate

Na₂SO₄, a salt formerly used as a saline cathartic and diuretic, and now used in the manufacture of detergents. The salt grows in the pores of bricks and stones, causing them to crack from the pressure. Synonym: Glauber salt

CAS # 7727-73-3

sodium thiosulfate

Na₂O₃S₂, a white crystalline substance used externally to remove stains of iodine and intravenously as an antidote for cyanide poisoning.

CAS # 7772-98-7

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sodium polyanethol sulfonate

Abbreviation: SPS

A polyanionic detergent and antimicrobial agent used in microbiological assays to enhance recovery of bacteria.

CAS # 63589-56-0

See also: sodium