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Polystyrene sulfonate
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Polystyrene sulfonate
Polystyrene sulfonates are a group of medications used to treat high blood potassium. Therapeutic effects generally appear hours to days after commencement of therapy. Common side effects include loss of appetite, gastrointestinal upset, constipation, and low blood calcium. Polystyrene sulfonates are given by mouth with a meal, or rectally by retention enema. Oral formulations often also contain the laxative sorbitol in order to lessen the risk of constipation which can be severe.
Polystyrene sulfonates are derived from polystyrene by the addition of sulfonate functional groups.[citation needed] Sodium polystyrene sulfonate was approved for medical use in the United States in 1958. A polystyrene sulfonate was developed in the 2000s to treat Clostridioides difficile associated diarrhea under the name Tolevamer, but it was never marketed.
Polystyrene sulfonates are also used in technical applications to remove potassium, calcium, and sodium from solutions.
Polystyrene sulfonate is typically supplied in the form of either a sodium or a calcium salt. It is used medically as a potassium binder in hyperkalemia (high blood potassium) occurring in the context of acute and chronic kidney disease. The medication has a delayed onset of action and is effective in sequestering potassium over the longer-term, however, its effectiveness in acute management of hyperkalemia is tenuous.[better source needed]
Intestinal disturbances are common, including loss of appetite, nausea, vomiting, and constipation. Constipation can be severe, culminating in life-threatening fecal impaction.[better source needed] In rare cases, use has been associated with colonic necrosis.
Severe gastrointestinal complications are relatively rare, however, use of this medication is widespread (e.g., about 5 million doses prescribed per year in the U.S.) in spite of poor evidence for its efficacy and availability of alternative treatments, so a large population of patients is subject to potentially unnecessarily risk of GI injury. No statistically rigorous evidence regarding the actual incidence of severe GI adverse effects with this medication is available.
GI injury occurs both with polystyrene sulfonate alone or in formulations containing sorbitol. It can occur with oral or rectal administration. Polystyrene sulfonate may be directly toxic to the intestinal mucosa, inducing a local inflammatory response that causes vascular injury. Co-administration of sorbitol is thought to compound the risk of GI injury by independently promoting vascular injury by causing vasospasm and prostaglandin-mediated pro-inflammatory effects.
Mortality in cases with severe GI injury is high (possibly due to co-morbidities in affected patients). The large intestine is most commonly affected, however, with oral administration, more proximal GI segments (including the stomach and oesophagus) are affected in about 30% of cases (usually with concurrent large intestine involvement). Milder and less clearly attributable cases of GI injury may go unnoted.
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Polystyrene sulfonate
Polystyrene sulfonates are a group of medications used to treat high blood potassium. Therapeutic effects generally appear hours to days after commencement of therapy. Common side effects include loss of appetite, gastrointestinal upset, constipation, and low blood calcium. Polystyrene sulfonates are given by mouth with a meal, or rectally by retention enema. Oral formulations often also contain the laxative sorbitol in order to lessen the risk of constipation which can be severe.
Polystyrene sulfonates are derived from polystyrene by the addition of sulfonate functional groups.[citation needed] Sodium polystyrene sulfonate was approved for medical use in the United States in 1958. A polystyrene sulfonate was developed in the 2000s to treat Clostridioides difficile associated diarrhea under the name Tolevamer, but it was never marketed.
Polystyrene sulfonates are also used in technical applications to remove potassium, calcium, and sodium from solutions.
Polystyrene sulfonate is typically supplied in the form of either a sodium or a calcium salt. It is used medically as a potassium binder in hyperkalemia (high blood potassium) occurring in the context of acute and chronic kidney disease. The medication has a delayed onset of action and is effective in sequestering potassium over the longer-term, however, its effectiveness in acute management of hyperkalemia is tenuous.[better source needed]
Intestinal disturbances are common, including loss of appetite, nausea, vomiting, and constipation. Constipation can be severe, culminating in life-threatening fecal impaction.[better source needed] In rare cases, use has been associated with colonic necrosis.
Severe gastrointestinal complications are relatively rare, however, use of this medication is widespread (e.g., about 5 million doses prescribed per year in the U.S.) in spite of poor evidence for its efficacy and availability of alternative treatments, so a large population of patients is subject to potentially unnecessarily risk of GI injury. No statistically rigorous evidence regarding the actual incidence of severe GI adverse effects with this medication is available.
GI injury occurs both with polystyrene sulfonate alone or in formulations containing sorbitol. It can occur with oral or rectal administration. Polystyrene sulfonate may be directly toxic to the intestinal mucosa, inducing a local inflammatory response that causes vascular injury. Co-administration of sorbitol is thought to compound the risk of GI injury by independently promoting vascular injury by causing vasospasm and prostaglandin-mediated pro-inflammatory effects.
Mortality in cases with severe GI injury is high (possibly due to co-morbidities in affected patients). The large intestine is most commonly affected, however, with oral administration, more proximal GI segments (including the stomach and oesophagus) are affected in about 30% of cases (usually with concurrent large intestine involvement). Milder and less clearly attributable cases of GI injury may go unnoted.
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