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Complications following oral administration of exchange resins in extremely low-birth-weight infants
1University of Toronto Perinatal Complex, Women's College Hospital, Ontario, Canada.
Insights
Oral administration of sodium polystyrene sulfonate and calcium polystyrene sulfonate exchange resins for hyperkalemia can cause serious complications in extremely low-birth-weight infants, leading to gastric obstruction.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Pharmacology
Background:
- Hyperkalemia is a critical condition in extremely low-birth-weight (ELBW) infants.
- Exchange resins like sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) are used to manage hyperkalemia.
- Gastrointestinal complications associated with these resins in ELBW infants are not well-documented.
Purpose of the Study:
- To report complications arising from the oral use of SPS and CPS in ELBW infants.
- To investigate the nature of these complications and identify risk factors.
Main Methods:
- Retrospective case series of five ELBW infants treated with oral SPS or CPS for hyperkalemia.
- Clinical observation, palpation, radiographic imaging (X-ray), and autopsy findings.
- X-ray diffraction analysis of gastric concretions.
Main Results:
- All five infants developed radio-opaque masses in the stomach.
- These masses were palpable in the upper abdomen.
- Autopsy in two infants revealed chalk-like concretions identified as Brushite (calcium phosphate salt).
Conclusions:
- Oral administration of SPS and CPS can lead to gastric obstruction due to Brushite concretions in ELBW infants.
- The gastric route for administering these resins should be avoided in critically ill ELBW infants.
- This highlights a significant safety concern for a common treatment modality in neonatology.
Abstract:
Complications of the oral use of sodium polystyrene sulfonate and calcium polystyrene sulfonate are reported in five extremely low-birth-weight infants in which exchange resins were used to treat hyperkalemia. Radio opaque masses outlining the stomach were seen in all infants and could be palpated in the left upper quadrant of the abdomen. In two infants, at autopsy the palpable mass could be identified as a solid chalk-like concretion outlining the stomach. X-ray diffraction studies identified the material as Brushite. Administration of exchange resins by the gastric route should be avoided in the treatment of hyperkalemia in critically sick, extremely low-birth-weight infants.