Calcium polystyrene sulfonate-induced gastrointestinal tract necrosis and perforation

摘要

To the Editor, Hyperkalaemia is defined as a high serum potassium level requiring urgent and specific treatments to prevent life-threatening complications. Cation-exchange resin, such as calcium polystyrene sulfonate (CPS), promotes potassium excretion in the intestinal/colonic lumen and is a treatment of choice when less aggressive treatment is allowed (1). We herein present three cases of CPS-induced gastrointestinal tract necrosis or perforation. The patients were a 61-year-old man (Patient 1) and two women aged 74 and 89 years, respectively (Patients 2 and 3). All had multiple comorbidities such as chronic kidney disease or heart disease. Patients 1 and 2 were in a postoperative state. The CPS dosages were 60, 75, and 90 g/day orally for 2 to 3 days, with a total CPS dose of 210, 150, and 180 g without sorbitol, respectively. No patients had evidence of infection, vascular thrombosis, or other significant pre-existing causes of bowel necrosis/ perforation. No nonsteroidal anti-inflammatory and/or anticoagulant drugs had been prescribed within 3 weeks prior to the incidents. The surgical specimen from Patient 1 included hard, stony intestinal contents.