| SODIUM POLYSTYRENE SULFONATE
Kayexalate, SPS Suspension
Classifications: electrolyte and water balance agent; cation exchange; Therapeutic: cation exchange
Pregnancy Category: C
15 g/60 mL suspension; 100 mg/g powder
Sulfonic cation-exchange resin that removes potassium from body by exchanging sodium ion for potassium, particularly in
large intestine; potassium-containing resin is then excreted through the bowel. Small amounts of other cations such as calcium
and magnesium may be lost during treatment.
Removes potassium from body by exchanging sodium ion for potassium through the large intestine.
Patients with hypokalemia; hypersensitivity to Kayexalate; GI obstruction; hypocalcemia, hypokalemia; pregnancy (category
Older adults; acute or chronic kidney failure; low birth weight infants; neonates with reduced gut; patients receiving digitalis
preparations; patients who cannot tolerate even a small increase in sodium load (e.g., CHF, severe hypertension, and marked
Route & Dosage
Adult: PO 15 g suspended in 70% sorbitol or 20100 mL of other fluid 14 times/d PR 3050 g/100 mL 70% sorbitol q6h as warm emulsion high into sigmoid colon
Child: PO Calculate appropriate amount on exchange rate of 1 mEq of potassium per gram of resin and suspend in 70% sorbitol or
other appropriate solution (usual dose: 1 g/kg q6h) PR 1 g/kg q26h
- Give as a suspension in a small quantity of water or in syrup. Usual amount of fluid ranges from 20100 mL or approximately
34 mL/g of drug.
- Use warm fluid (as prescribed) to prepare the emulsion for enema.
- Administer at body temperature and introduce by gravity, keeping suspension particles in solution by stirring. Flush suspension
with 50100 mL of fluid; then clamp tube and leave it in place.
- Urge patient to retain enema at least 3060 min but as long as several hours if possible.
- Irrigate colon (after enema solution has been expelled) with 1 or 2 qt flushing solution (non-sodium containing). Drain
returns constantly through a Y-tube connection.
- Store remainder of prepared solution for 24 h; then discard.
Adverse Effects (≥1%)GI: Constipation, fecal impaction (in older adults);
anorexia, gastric irritation, nausea, vomiting, diarrhea
(with sorbitol emulsions). Metabolic:
Sodium retention, hypocalcemia, hypokalemia, hypomagnesemia.
may decrease potassium exchange capability of the resin.
Not absorbed systemically. Onset:
Several hours to days. Metabolism:
Not metabolized. Elimination:
Assessment & Drug Effects
- Lab tests: Determine serum potassium levels daily throughout therapy. Monitor acidbase balance, electrolytes, and
minerals in patients receiving repeated doses.
- Serum potassium levels do not always reflect intracellular potassium deficiency. Observe patient closely for early clinical
signs of severe hypokalemia (see Appendix F). ECGs are also recommended.
- Consult physician about restricting sodium content from dietary and other sources since drug contains approximately 100
mg (4.1 mEq) of sodium per gram (1 tsp, 15 mEq sodium).
Patient & Family Education
- Check bowel function daily. Usually, a mild laxative is prescribed to prevent constipation (common adverse effect). Older
adult patients are particularly prone to fecal impaction.