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Updated: Nov 7, 2025

Estimation of Urinary Nanocrystals in Humans using Calcium Fluorophore Labeling and Nanoparticle Tracking Analysis
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Small crystals with severe consequences.

Jennifer M Klasen1, Caspar J Peterson1, Lana L Fourie1

  • 1Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.

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|April 30, 2021
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Summary
This summary is machine-generated.

A young patient experienced severe gastric necrosis after taking sodium polystyrene sulfonate (SPS), a medication for hyperpotassemia. This rare case highlights the risk of kayexalate crystal residues causing gastrointestinal injury, necessitating physician awareness.

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Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Clinical Toxicology

Background:

  • Sodium polystyrene sulfonate (SPS), commonly known as Kayexalate, is widely used to manage hyperkalemia.
  • While generally effective, SPS can cause gastrointestinal complications due to crystal formation within the digestive tract.
  • These complications, though rare, can be severe, including ulceration and necrosis.

Observation:

  • A 23-year-old patient developed acute gastric ischemia and full-thickness gastric necrosis following a single oral dose of SPS.
  • Emergency surgery was required for a total gastrectomy to address the extensive tissue damage.
  • Histopathological examination revealed the presence of kayexalate crystals within the gastric wall.

Findings:

  • The findings indicate a direct link between SPS ingestion and severe ischemic gastritis.
  • The formation of kayexalate crystal residues in the stomach can precipitate life-threatening gastrointestinal necrosis.
  • This case underscores that SPS-induced gastrointestinal injury can occur in the upper GI tract, not exclusively the lower GI tract.

Implications:

  • Physicians must maintain a high index of suspicion for SPS-related gastrointestinal adverse events, even with single-dose oral use.
  • Awareness of this rare but severe complication is crucial for patient safety when prescribing SPS for hyperkalemia.
  • The potential for kayexalate crystal residue formation necessitates careful consideration of alternative treatments or vigilant monitoring in susceptible patients.