sodium polystyrene sulfonate

Kalexate

Kayexalate

K-Exit

Kionex

SPS

Indications

Action

Pharmacokinetics

Time/action profile (decrease in serum potassium)

Contraindications/Precautions

Adverse Reactions/Side Effects

Gastrointestinal

• intestinal necrosis (life-threatening)
• constipation (most frequent)
• fecal impaction (most frequent)
• anorexia
• gastric irritation
• ischemic colitis
• nausea
• vomiting

Fluid and Electrolyte

• hypocalcemia
• hypokalemia
• sodium retention
• hypomagnesemia

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor response of symptoms of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QT segments, widened QRS complexes, loss of P waves, and cardiac arrhythmias). Assess for development of hypokalemia (weakness, fatigue, arrhythmias, flat or inverted T waves, prominent U waves).
• Monitor intake and output ratios and daily weight. Assess for symptoms of fluid overload (dyspnea, rales/crackles, jugular venous distention, peripheral edema). Concurrent low-sodium diet may be ordered for patients with HF (see ).
• In patients receiving concurrent digoxin, assess for symptoms of digoxin toxicity (anorexia, nausea, vomiting, visual disturbances, arrhythmias).
• Assess abdomen and note character and frequency of stools. Discontinue sodium polystyrene sulfonate if patient becomes constipated. Concurrent sorbitol or laxatives may be ordered to prevent constipation or impaction. Some products contain sorbitol to prevent constipation. Patient should ideally have 1–2 watery stools each day during therapy. Monitor for intestinal necrosis if sorbitol is added.
• Lab Test Considerations: Monitor serum potassium daily during therapy. Notify health care professional when potassium ↓ to 4–5 mEq/L.
  • Monitor renal function and electrolytes (especially sodium, calcium, bicarbonate, and magnesium) prior to and periodically throughout therapy.

Potential Nursing Diagnoses

Implementation

• Solution is stable for 24 hr when refrigerated.
  • Consult health care professional regarding discontinuation of medications that may increase serum potassium (angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, potassium supplements, salt substitutes).
• An osmotic laxative (sorbitol) is usually administered concurrently to prevent constipation.
• Oral: For oral administration, shake commercially available suspension well before use. When using powder, add prescribed amount to 3–4 mL water/g of powder. Shake well. Syrup may be ordered to improve palatability. Resin cookie or candy recipes are available; discuss with pharmacist or dietitian.
• Retention Enema: Precede retention enema with cleansing enema. Administer solution via rectal tube or 28-French Foley catheter with 30-mL balloon. Insert tube at least 20 cm and tape in place.
  • For retention enema, add powder to 100 mL of prescribed solution (usually sorbitol or 20% dextrose in water). Shake well to dissolve powder thoroughly; should be of liquid consistency. Position patient on left side and elevate hips on pillow if solution begins to leak. Follow administration of medication with additional 50–100 mL of diluent to ensure administration of complete dose. Encourage patient to retain enema as long as possible, at least 30–60 min.
  • After retention period, irrigate colon with 1–2 L of non–sodium-containing solution. Y-connector with tubing may be attached to Foley or rectal tube; cleansing solution is administered through 1 port of the Y and allowed to drain by gravity through the other port.

Patient/Family Teaching

• Explain purpose and method of administration of medication to patient.
• Advise patient to avoid taking antacids or laxatives during therapy, unless approved by health care professional; may cause systemic alkalosis.
• Advise female patient to notify health care professional if pregnant or breast feeding.
• Inform patient of need for frequent lab tests to monitor effectiveness.

Evaluation/Desired Outcomes

• Normalization of serum potassium levels.

The normal sodium level in serum is 135 to 145 mmol/L. A decreased level of sodium in the serum is called hyponatremia, an increased level, hypernatremia. These conditions per se are not usually excesses or deficiencies of sodium but rather disturbances in the body's regulation of water, i.e., a change in measured sodium concentrations usually results from water retention or water depletion and not from too little or too much sodium in the body. Synonym: natrium See: hypernatremia; hyponatremia

CAUTION!

CAUTION!