A patient with hyperkalemia is often given a cation-exchange resin to remove excess potassium. Occasionally the patient may developed necrosis of the bowel mucosa.
Cation-exchange resins:
(1) sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol
(2) calcium polystyrene sulfonate (Kalimate)
Colonic mucosal injury is more common and can occur with either oral dosing or rectal enema. Mucosal damage can also affect the esophagus, stomach and duodenum.
Risk factors:
(1) renal failure, uremia
(2) critical care
Presentation:
(1) abdominal pain
(2) gastrointestinal bleeding including hematochezia (anal passage of fresh blood)
(3) peritonitis from bowel perforation
Crystals may be seen in biopsies taken from damaged mucosa.
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