Abstract
Objective
To describe the safety and efficacy of sodium polystyrene sulfonate (SPS) in pediatric patients with acute hyperkalemia.
Methods
A retrospective chart review of all patients less than 18 years of age administered SPS for acute hyperkalemia at Texas Children’s Hospital between 2011 and 2014.
Results
Our cohort consisted of 156 patients (mean age 6.8 ± 6.1 years). The peak mean potassium concentration observed was 6.5 ± 0.77 mmol/l prior to administration of SPS. The mean SPS dose was 0.64 ± 0.32 g/kg. The majority (91 %) of the SPS doses were given orally. The nadir mean potassium concentration in the 48 h post-SPS was 4.7 ± 1.2 mEq/l, which occurred at 16.7 ± 14.7 h post-dose. In the 48 h following SPS administration, 68 (43 %) patients required at least one additional intervention after SPS dose. Patients who required an additional intervention after initial SPS dose differed significantly in weight, baseline serum potassium, and were more likely to have received SPS treatment via the rectal route. A gastrointestinal adverse event was documented in 24 (15 %) patients.
Conclusions
SPS was used effectively and safely in the majority of patients in this report. However, it may not be appropriate as a first single-line agent in patients with severe acute hyperkalemia who require a greater than 25 % reduction in serum potassium levels or those at a high risk for cardiac arrhythmias.
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On behalf of the authors, the corresponding author states that there are no conflicts of interest to declare. There is no potential conflict of interest, real or perceived, in the preparation of this manuscript and no funding was received for preparation of this manuscript. Brady S. Moffett, PharmD, MPH wrote the first draft of the manuscript, and Ji Lee, PharmD has approved the final draft. The authors report no conflicts of interest including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.
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Lee, J., Moffett, B.S. Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate. Pediatr Nephrol 31, 2113–2117 (2016). https://doi.org/10.1007/s00467-016-3414-5
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DOI: https://doi.org/10.1007/s00467-016-3414-5