Uses
Hyperkalemia
Treatment of hyperkalemia. Used as an adjunct to other measures (e.g., restriction of electrolyte intake, control of acidosis, high-calorie diet).
Prior to initiating therapy, determine cause of hyperkalemia and eliminate if possible.
Not recommended for treatment of hyperkalemia evidenced by conduction defects (widening of the QRS complex) or arrhythmias because action of the resin is slow.
Most useful when hyperkalemia is not life-threatening or when other measures have reduced the dangers of hyperkalemia.
Dosage and Administration
General
- Dosage and duration of therapy must be individualized and depend on daily assessment of total body potassium.
Administration
Administer orally or rectally.
Oral Administration
Administer orally as a suspension (either as the commercially available suspension or prepared extemporaneously from the powdered resin).
Suspension also may be introduced into the stomach via a tube.
Prior to administration, shake suspension well.
Reconstitution
Reconstitute each 1 g of the powdered resin in 3–4 mL of water or a syrup; usually 20–100 mL of fluid is used.
Powdered resin may be mixed with a diet appropriate for a patient in renal failure. Do not mix with foods or liquids that contain a large amount of potassium (e.g., bananas, orange juice).
Rectal Administration
Administer rectally as a retention enema by gravity feed (either as the commercially available suspension or prepared extemporaneously from the powdered resin).
Prior to administration, administer an initial cleansing enema, and then insert a soft, large (French 28) rubber tube about 20 cm into the rectum, with the tip well into the sigmoid colon, and tape in place.
Prior to administration, warm suspension to body temperature and shake well.
During administration, extemporaneously prepared suspension should be kept in suspension by stirring. The tube may be flushed with 50–100 mL of fluid, clamped, and left in place. If back-leakage occurs, the hips should be elevated on pillows or a knee-chest position assumed.
Retain suspension in the colon for at least 30–60 minutes or for several hours if possible, then irrigate the colon with a non-sodium containing solution at body temperature to remove the resin. Returns should be drained constantly through a Y tube connection. Approximately 2 L of irrigating solution may be needed to adequately flush out the resin; proper removal of resin is particulary important when sorbitol is used.
Alternatively, some clinicians recommend placing the resin in a sealed dialysis bag and inserting the bag into the rectum.
Reconstitution
Suspend appropriate dose of powdered resin in 100–200 mL of an aqueous vehicle (e.g., 25% sorbitol, 1% methylcellulose, 10% dextrose, water) at body temperature.
A thicker suspension may be used; however, care should be taken that a paste, which would greatly reduce the exchange surface and be particularly ineffective if deposited in the rectal ampulla, is not formed.
Dosage
Pediatric Patients
Hyperkalemia
Oral
Infants and small children: Reduced dosage recommended. Calculate dosage based on the fact that 1 g of the resin binds approximately 1 mEq of potassium.
Oral administration not recommended in neonates. (See Contraindications under Cautions.)
Rectal
Reduced dosage recommended. Calculate dosage based on the fact that 1 g of the resin binds approximately 1 mEq of potassium.
Use with caution. (See Pediatric Use under Cautions.)
Adults
Hyperkalemia
Oral
15 g (approximately 4 level teaspoonfuls of the powder or 60 mL of the commercially available suspension) 1–4 times daily (average 15–60 g daily).
Rectal
30–50 g (120–200 mL of the commercially available suspension) every 6 hours or as necessary.
Prescribing Limits
Adults
Hyperkalemia
Oral
15 g 4 times daily (60 g daily).
Rectal
50 g every 6 hours.
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