HYPERKALEMIA NEJM PDF

Email: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract This article focuses on the pathogenesis, clinical manifestations, and various treatment modalities for acute hyperkalemia and presents a systematic approach to selecting a treatment strategy.

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J Am Soc Nephrol May Recent evidence fuels growing concerns about use of sodium polystyrene sulfonate with sorbitol. Sodium polystyrene sulfonate SPS; e. SPS is an ion exchange resin that is thought to exchange sodium with potassium in the colon.

Because constipation is a common complication, SPS is often mixed with sorbitol. In a clinical commentary, the authors reviewed the literature on SPS and sorbitol from the past 50 years and found no evidence of clinically significant lowering of serum potassium in patients with hyperkalemia.

The strongest evidence for SPS efficacy is a drop in serum potassium of at least 0. A recent report described colonic necrosis in patients treated with SPS mixed with sorbitol South Med J ; In September , the FDA issued a warning about concomitant use of SPS with sorbitol, although this combination is currently still available. Comment As a nephrologist who has used sodium polystyrene sulfonate for decades, I found this review startling.

Although I was aware that the beneficial effect of SPS was, at best, slow and gradual, I was unaware about the risk for intestinal injury when SPS is combined with sorbitol.

Fortunately, more rapid and effective measures are available to lower serum potassium in patients with hyperkalemia. On the basis of this commentary and literature review, I discourage prescribing SPS with sorbitol as a first-line therapy for hyperkalemia. Citation s : Sterns RH et al. Ion-exchange resins for the treatment of hyperkalemia: Are they safe and effective? J Am Soc Nephrol May;

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HYPERKALEMIA NEJM PDF

J Am Soc Nephrol May Recent evidence fuels growing concerns about use of sodium polystyrene sulfonate with sorbitol. Sodium polystyrene sulfonate SPS; e. SPS is an ion exchange resin that is thought to exchange sodium with potassium in the colon. Because constipation is a common complication, SPS is often mixed with sorbitol. In a clinical commentary, the authors reviewed the literature on SPS and sorbitol from the past 50 years and found no evidence of clinically significant lowering of serum potassium in patients with hyperkalemia. The strongest evidence for SPS efficacy is a drop in serum potassium of at least 0.

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Vusida Several co-transporters hypeekalemia ion channels are involved in the complex regulatory system of potassium reabsorption. Transient type 1 pseudo-hypoaldosteronism: Enemas should be retained at least min. More effective if given orally. In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. Diagnostic algorithm in hyperkalemia; adapted from Clinical Paediatric Nephrology. Life-threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment. Pathogenesis, diagnosis and management of hyperkalemia Open in a separate window.

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