Kalimate (calcium polystyrene sulfonate) and bowel perforation – a cause not to be ignored

Kalimate (calcium polystyrene sulfonate) and bowel perforation – a cause not to be ignored

Carolina Marques, Cátia Ferreira, Rita Marques, Ricardo Vaz-Pereira, Urânia Fernandes, Gonçalo Guidi, João Pinto-deSousa

Centro Hospitalar de Trás-os-Montes e Alto Douro.

Calcium polystyrene sulfonate (CPS), also known as Kalimate, is a cationexchange resin (CER), commonly used to treat hyperkalemia. A case of a patient with chronic kidney disease (CKD) who underwent right hemicolectomy for colonic perforation due to intestinal necrosis secondary to oral CPS administration is presented. The histopathological findings confirmed the colonic ischemia and perforation and showed a luminal deposition of crystals with a fish scale pattern, compatible with CER (Kalimate). This report aims to present and discuss this unusual case considering the most updated scientific evidence.

Keywords: kalimate, cation exchange resin, hyperkalemia, bowel perforation

Free Full-text PDF

How to cite this article:

Carolina Marques, Cátia Ferreira, Rita Marques, Ricardo Vaz-Pereira, Urânia Fernandes, Gonçalo Guidi, João Pinto-deSousa. Kalimate (calcium polystyrene sulfonate) and bowel perforation – a cause not to be ignored. International Journal of Case Reports, 2022, 6:263. DOI: 10.28933/ijcr-2021-11-2805

References:

1. Mattu A, Brady WJ, Robinson DA. Electrocardi-ographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18(6):721-729. doi:10.1053/ ajem.2000.7344
2. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a sys-tematic review. Am J Med. 2013;126(3): 264.e9-24. doi:10.1016/j.amjmed.2012.08.016
3. Wu Y-H, Chou J-W, Lai H-C, Su G-S, Cheng K-S, Chen T-W. Adverse Gastrointestinal Effects with Kayexalate or Kalimate: A Comprehensive Re-view. Clin Exp Gastroenterol. 2021;14:1-18. doi:10.2147/CEG.S278812
4. Wu Y-H, Chen T-W, Chou J-W. Kalimate-Induced Upper Gastrointestinal Bleeding in a 77-Year-Old Woman. Clin Gastroenterol Hepatol. 2020;18(9): e104-e105. doi:10.1016/j.cgh.2019.05.006
5. McGowan CE, Saha S, Chu G, Resnick MB, Moss SF. Intestinal necrosis due to sodium pol-ystyrene sulfonate (Kayexalate) in sorbitol. South Med J. 2009;102(5):493-497. doi:10.1097/SMJ. 0b013e31819e8978
6. Lillemoe KD, Romolo JL, Hamilton SR, Pen-nington LR, Burdick JF, Williams GM. Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery. 1987;101(3): 267-272. http://www.ncbi.nlm.nih.gov/pubmed/3824154
7. Murakami K, Nakamura Y, Miyasaka Y, Sato T, Kawagishi N, Sasano H. Intestinal necrosis re-lated to administration of cation exchange resin without sorbitol: A retrospective analysis of 61 patients with end‐stage renal diseases. Pathol Int. 2020;70(5):270-279. doi:10.1111/pin.12906
8. Arvanitakis C, Malek G, Uehling D, Morrissey JF. Colonic complications after renal transplantation. Gastroenterology. 1973;64(4):533-538. http://www.ncbi.nlm.nih.gov/pubmed/4144776
9. Joo M, Bae WK, Kim NH, Han SR. Colonic mu-cosal necrosis following administration of calcium polystryrene sulfonate (Kalimate) in a uremic pa-tient. J Korean Med Sci. 2009;24(6):1207-1211. doi:10.3346/jkms.2009.24.6.1207
10. Dunlap RH, Martinez R. Total colectomy for colon perforation after kayexalate administration: a case report and literature review of a rare com-plication. J Surg case reports. 2016;2016(10). doi:10.1093/jscr/rjw167
11. Piwchan S, Sripariwuth E, Sitthichaiyakul P. Calcium Polystyrene Sulfonate Associated Co-lonic Mucosal Injury-Innocent Bystander or Pathogenic Culprit?: A Case Report and Literature Review. Ann Coloproctol. Published online May 28, 2021. doi:10.3393/ac.2021.03.19
12. Kim T, de Oliveira Silva Lautenschlager S, Ma Q, et al. Drug Crystal-Related Gastrointestinal Complications Involve Crystal-Induced Release of Neutrophil and Monocyte Extracellular Traps. Cells. 2020;9(11). doi:10.3390/cells9112481
13. Georgianos PI, Liampas I, Kyriakou A, et al. Evaluation of the tolerability and efficacy of so-dium polystyrene sulfonate for long-term man-agement of hyperkalemia in patients with chronic kidney disease. Int Urol Nephrol. 2017;49(12): 2217-2221. doi:10.1007/s11255-017-1717-5