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Kayexalate Colonic Necrosis — ESENeph MCQ

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ModerateElectrolyte DisordersKayexalate Colonic NecrosisESENeph

A 55-year-old woman on haemodialysis has chronic constipation. She is prescribed Sodium Polystyrene Sulfonate (Kayexalate) for hyperkalaemia and takes it with Sorbitol. She develops severe abdominal pain and bloody diarrhoea. CT shows colonic wall thickening. What complication has occurred?

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Correct answer: D — Colonic necrosis (intestinal necrosis) associated with Sodium Polystyrene Sulfonate

Sodium Polystyrene Sulfonate (SPS/Kayexalate), particularly when co-administered with Sorbitol, is associated with colonic necrosis – a rare but potentially fatal complication. The mechanism involves direct mucosal injury from SPS crystals and osmotic injury from Sorbitol. FDA issued a warning about this combination. This risk is another reason KDIGO 2024 and international guidelines prefer newer potassium binders (Patiromer, SZC) which have much better safety profiles.

Reference: FDA Safety Alert – SPS/Sorbitol; Harel et al 2013 – SPS GI Necrosis