sodium polystyrene sulfonate
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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 polystyrene sulfonate
Pharmacologic class: Cation exchange resin
Therapeutic class: Potassium-removing resin
Pregnancy risk category C
Exchanges sodium ions for potassium ions in intestine; potassium is then eliminated in feces, which decreases serum potassium level.
Oral or rectal powder for suspension: 15 g/4 level teaspoons
Suspension: 15 g/60 ml
Indications and dosages
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
• Hypersensitivity to drug
• Hypokalemia or other electrolyte imbalances
• Obstructive bowel disease
• Neonates with reduced gut motility; oral administration in neonates
Use cautiously in:
• renal or heart failure, severe edema, severe hypertension
• concomitant administration of sorbitol (use not recommended)
• pregnant patients
• children (efficacy not established).
• 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.
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
Drug-drug. Antacids, laxatives: systemic alkalosis
Drug-diagnostic tests. Calcium, magnesium, potassium: decreased levels
Sodium: increased level
☞ 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.
• 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.