Sodium Polystyrene Sulfonate

A to Z Drug Facts

 Action Resin that exchanges sodium ions for potassium in large intestine.

 Indications Treatment of hyperkalemia.

 Contraindications Hypokalemia.

 Route/Dosage

ADULTS: PO or via NG tube 15 g 1 to 4 times/day. PR 30 to 50 g q 6 hr has been given as daily enema. CHILDREN: PO Calculate children's dose by exchange ratio of 1 mEq potassium per gram of resin. (1 g/kg q 6 hr has been recommended.)

 Interactions

Digitalis: If hypokalemia occurs, likelihood of toxic effects of digoxin may be increased. Nonabsorbable cation donating antacids and laxatives (eg, aluminum carbonate, magnesium hydroxide): Systemic alkalosis has occurred. Potassium exchange capability of sodium polystyrene sulfonate may be reduced. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination has occurred.

 Lab Test Interferences None well documented.

 Adverse Reactions

GI: Gastric irritation; anorexia; nausea; vomiting; constipation; fecal impaction. META: Hypokalemia; hypocalcemia; sodium retention.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Electrolyte abnormalities: Serious potassium deficiency can occur. Sodium polystyrene sulfonate is not totally selective for potassium and small amounts of magnesium and calcium can be lost. Use with caution in patients who cannot tolerate even small increase in sodium load (ie, severe congestive heart failure, severe hypertension, marked edema). Severe hyperkalemia: Treatment with this drug alone may be insufficient to rapidly correct severe hyperkalemia associated with states of rapid tissue breakdown (eg, burns, renal failure) or hyperkalemia so marked as to constitute medical emergency.

 Administration/Storage

• Oral powder: Shake bottle well before administration. Give each dose as suspension in water or, for greater palatability, in syrup. Use sorbitol to combat constipation. Oral suspensions contain sorbitol and sodium. Resin may be introduced into stomach through plastic tube; if desired, mixed with appropriate diet. Never mix with orange juice because of high potassium content.
• Retention enema: After initial cleansing enema, insert soft, large (28 F) rubber tube into the rectum about 20 cm, with tip well into sigmoid colon, and tape in place. Elevate hips to prevent leakage. After administration, flush suspension with 50 to 100 ml of fluid, clamp tube and leave in place. Keep suspension in sigmoid colon for several hrs. Then irrigate colon with approximately 2 L of non-sodium-containing solution. Drain return through Y-tube connection.
• Store at room temperature. Store repackaged product in refrigerator and use within 14 days. Do not store freshly prepared suspensions longer than 24 hr. Do not heat, because this may alter exchange of properties of resin.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess GI function. Use caution in elderly because of predisposition to fecal impaction.
• Assess electrolyte levels including sodium, potassium, calcium and magnesium.
• Use caution with patients who have tendencies toward hypernatremia or hypertension or who are receiving digitalis preparations.
• Assess vital signs each shift.
• Monitor serum potassium and sodium daily and observe for signs and symptoms of hypokalemia, including irritability, confusion, cardiac arrhythmias, ECG changes and muscle weakness.
• Observe for signs of sodium overload, such as edema.
• Closely monitor patients on sodium restriction.
• Monitor serum calcium levels. If deficient, patient may require supplements.
• Observe for changes in bowel function. Report to physician if patient becomes constipated.

 Patient/Family Education

• Tell patient not to mix medication with fruit juice.
• Instruct patient to shake bottle well before taking medication.
• Advise patient to report any water retention or edema.
• Instruct patient to report these symptoms to physician: anorexia, nausea, vomiting and any changes in bowel function.
• Tell patient not to take otc medications without consulting physician.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts