Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: Case report and review of the literature

Patients with renal insufficiency are particularly prone to electrolyte abnormalities, especially hyperkalemia, which can be life threatening. One of the methods to treat hyperkalemia is with sodium polystyrene sulfonate (Kayexalate), a cation-exchange resin that can be administered either as an enema, orally, or by nasogastric tube. Sorbitol is a hypertonic mixture that is frequently mixed with sodium polystyrene sulfonate to prevent constipation from the resin. The case reported herein is a catastrophic complication of colonic necrosis that we believe was caused by sodium polystyrene sulfonate and sorbitol enemas that were administered to treat the patient's acute hyperkalemia. This was evidenced by the characteristic crystallized material in the necrotic colon and the fact that the colonic necrosis extended down to the anal verge (a richly vascularized area of the colon usually not prone to ischemia).