P119 | A case of Kayexalate-induced colitis

V. Pedini, L. Maulucci, A. Pulcina, P. De Togni, C. Pinzi, M. Pagani | SC. Medicina Generale, Ospedale C. Poma, ASST Mantova, Italy

Premises: Sodium Polystyrene Sulfonate (SPS) or Kayexalate is commonly used to treat hyperkalemia since 1960s. Common side effects include constipation, bloating, nausea, and vomiting. Colitis is rarely described and can result in severe complications such as perforation, necrosis and strictures.
Description of the Case report: We describe the case of a 70-years-old Caucasian woman admitted to our department for rectal bleeding with secondary anemia. Her clinical history comprises renal and cardiac amiloidosis, multiple myeloma with end stage chronic kidney disease (CKD) in treatment with hemodialysis. She chronically assumed SPS, for hyperkalemia secondary to CKD. She was treated with blood transfusion and she underwent colonoscopy which revealed a suspect ischemic cecal colitis. Biopsy of the colon were performed and the histological examination documented chronic ulcerative colitis kayexalate-related. Kayexalate was stopped and she was treated with mesalazine with benefit and resolution of the rectal bleeding.
Conclusions: Kayexalate is a cation-binding resin frequently used for the treatment of hyperkalemia. Intestinal injury due to SPS can result in ischemia, ulcerations, necrosis, perforation and occurs in about 0.27-1.8% of patients receiving Kayexalate. Clinical manifestation can mimic other gastrointestinal diseases such as ischemic colitis, infectious colitis or inflammatory bowel disease and diagnosis can be difficult. No specific treatment is known. Medication withdrawal is mandatory.