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Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate
Ji Lee1,2, Brady S Moffett3,4
1Department of Pharmacy, Texas Children's Hospital, 6621 Fannin Street, Suite WB1120, Houston, TX, 77030, USA.
Insights
Sodium polystyrene sulfonate (SPS) effectively lowered potassium in most pediatric patients with acute hyperkalemia. However, it may not be suitable for severe cases or those at high risk for arrhythmias.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Acute hyperkalemia is a serious condition in pediatric patients, potentially leading to life-threatening cardiac arrhythmias.
- Sodium polystyrene sulfonate (SPS) is a medication used to reduce serum potassium levels.
Purpose of the Study:
- To evaluate the safety and efficacy of sodium polystyrene sulfonate (SPS) in treating acute hyperkalemia in pediatric patients.
- To identify patient characteristics and treatment parameters associated with SPS effectiveness and adverse events.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) treated with SPS for acute hyperkalemia.
- Data collection included patient demographics, serum potassium levels, SPS dosage and route, and subsequent interventions and adverse events.
Main Results:
- 156 pediatric patients received SPS for hyperkalemia (peak K+ 6.5 ± 0.77 mmol/l).
- Mean SPS dose was 0.64 ± 0.32 g/kg, mostly oral (91%).
- Nadir potassium in 48h was 4.7 ± 1.2 mEq/l. 43% required additional interventions; GI adverse events occurred in 15%.
Conclusions:
- SPS demonstrated safety and efficacy in the majority of pediatric patients with acute hyperkalemia.
- SPS may not be the optimal first-line agent for severe hyperkalemia or in patients at high risk for cardiac arrhythmias.
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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