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Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram infant with hyperkalemia
L N Bennett1, T F Myers, G H Lambert
1Department of Pediatrics, Loyola University, Maywood, Illinois 60153, USA.
Insights
Sodium polystyrene sulfonate enemas caused cecal impaction and perforation in a premature newborn. This hyperkalemia treatment may be ineffective and harmful for premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Toxicology
Background:
- Hyperkalemia is a critical condition in newborns, particularly premature infants.
- Sodium polystyrene sulfonate (SPS) is a potassium-binding resin used to treat hyperkalemia.
Observation:
- A 650g, 24-week gestational age infant developed severe hyperkalemia.
- Treatment with sodium polystyrene sulfonate enemas led to cecal impaction and perforation.
- Radiographs showed impacted resin; pathology confirmed SPS crystals in a cecal abscess.
Findings:
- Sodium polystyrene sulfonate enemas caused significant gastrointestinal complications in a premature neonate.
- The efficacy of SPS in reducing serum potassium in this gestational age group is questionable.
- SPS treatment may pose a detrimental risk to premature infants.
Implications:
- Clinical guidelines for hyperkalemia management in extremely premature infants may need re-evaluation.
- Alternative, safer methods for potassium reduction in neonates should be explored.
- This case highlights the potential risks of sodium polystyrene sulfonate in vulnerable infant populations.
Abstract:
We report a 650 g, 24 week hyperkalemic newborn who developed both cecal impaction and perforation after treatment with sodium polystyrene sulfonate enemas. Flat plate abdominal radiographs revealed impacted resin as a radiodense material outlining the bowel. Pathological examination showed sodium polystyrene sulfonate crystals contained in the cecal abscess. Review of the literature in both adults and children leads us to conclude that the use of this sodium-potassium exchange resin for the treatment of hyperkalemia in this gestational age group is probably not helpful for decreasing serum potassium and may be detrimental to the infant.