Names and pronunciation
(po-lee-stye′reen) Kalexate , Solystat , Kionex, SPS
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Drug reference
(po-lee-stye′reen) Kalexate , Solystat , Kionex, SPS
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Func. class.: Potassium-removing resin, antidote
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Chem. class.: Cation exchange resin
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ACTION: Removes potassium by exchanging sodium for potassium in body, primarily in large intestine
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USES: Hyperkalemia in conjunction with other measures
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CONTRAINDICATIONS: Hyper- sensitivity to saccharin or parabens that may be in some products, GI obstruction, neonate (reduced gut motility) Precautions: Pregnancy, geriatric patients, renal failure, HF, severe edema, severe hypertension, sodium restriction, constipation, GI bleeding, hypocalcemia
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SIDE EFFECTS GI: Constipation, anorexia, nausea, vom- iting, diarrhea (sorbitol), fecal impac- tion, gastric irritation META: Hypocalcemia, hypokalemia, hypomagnesemia, sodium retention
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INTERACTIONS Increase: hypokalemia—loop diuretics, cardiac glycosides Increase: metabolic alkalosis—magne- sium/calcium antacids Increase: colonic necrosis—sorbitol; do not use concurrently Decrease: effect of—lithium, thyroid hormones
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DOSAGE AND ROUTES • Adult: PO 15 g daily-qid; RECT enema S 30-50 g q1-2hr initially prn, then q6hr prn • Child (unlabeled): PO 1 g/kg q6hr prn; RECT 1 g/kg q2-6hr prn
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Available forms: Powder for susp 453.6 g, 454 g; oral susp 15 g/60 mL
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Administer: PO route • Powdered resin: given as a suspension in water or syrup; the amount of fluid ranges from 20 to 100 mL, depending on the dosage, or 3-4 mL/g of resin; suspen- sions should be freshly prepared and not stored for >24 hr; the powder should not be mixed with foods or liquids that con- tain a large amount of potassium (ba- nanas or orange juice) Rectal route • Precede retention enema with a cleans- ing enema • Use the suspension retained in the colon for at least 30-60 min or for sev- eral hours, if possible • After several hours have passed, adminis- ter a cleansing enema using a non–sodium- containing solution at body temperature; up to 2 quarts of fluid may be necessary; drain fluid through a Y-tube connection; observe the drainage if sorbitol was used
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Assess: • Hyperkalemia: serum potassium >5.5 mol/L; confusion, dyspnea, weakness, dysrhythmias; ECG for spiked T waves, depressed ST segments, prolonged QT and widening QRS complex • Hypokalemia: serum potassium <3.5 mmol/L; muscle weakness, polyuria, car- diac hyperexcitability with poor contrac- tility • Bowel function daily; note consistency of stools, times/day • Hypotension: confusion, irritability, muscular pain, weakness • Electrolytes: serum potassium, calcium, magnesium, sodium; acid-base balance • I&O ratio, weight daily; crackles, dys- pnea, jugular venous distention, edema • Digoxin toxicity (nausea, vomiting, blurred vision, anorexia, dysrhythmias) in those receiving digoxin
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Evaluate: • Therapeutic response: potassium level 3.5-5 mg/dL
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About reason for medication and ex- pected results • To follow a low-potassium diet, provide sample diet • To avoid laxatives, antacids, electro- lyte-based products unless approved by prescriber
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• Child (unlabeled): PO 1 g/kg q6hr prn; RECT 1 g/kg q2-6hr prn
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