{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:47:33Z","timestamp":1759938453195,"version":"3.37.3"},"reference-count":18,"publisher":"FapUNIFESP (SciELO)","issue":"8","license":[{"start":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T00:00:00Z","timestamp":1533081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T00:00:00Z","timestamp":1533081600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T00:00:00Z","timestamp":1533081600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY Sodium polystyrene sulfonate (PSP) or Kayexalate is a cation-exchange resin, widely used in the management of hyperkalaemia due to renal disease. A rare, yet potentially dangerous, adverse event related to sodium polystyrene sulfonate use is intestinal mucosal injury, especially in the colon. The injury to the gastrointestinal mucosa can range from mild and superficial to wall necrosis and bowel perforation. The mechanism that leads to mucosal damage remains unclear. However, it is believed that sorbitol, commonly given to counteract PSP\u2019s tendency to cause constipation, may play an important role in the development of gastrointestinal injury. Other potential risk factors are uraemia or end-stage renal disease, hemodynamic instability, solid organ transplantation, postoperative status and concomitant opioid administration. The authors present a case of diarrhoea and haematochezia after the administration of PSP without sorbitol, in a patient with hyperkalaemia due to acute kidney injury, in the absence of other risk factors. A colonoscopy was performed and revealed a rectal ulcer which histological findings were suggestive of mucosal injury due to Kayexalate deposition. This case supports the concept that this widely used drug can itself, without sorbitol, cause injury to the gastrointestinal wall. Even though this is a rare adverse effect, the widespread use of this medication may put a large population at risk.<\/jats:p>","DOI":"10.1590\/1806-9282.64.08.680","type":"journal-article","created":{"date-parts":[[2018,11,24]],"date-time":"2018-11-24T18:13:19Z","timestamp":1543083199000},"page":"680-683","source":"Crossref","is-referenced-by-count":6,"title":["Rectal ulcer due to Kayexalate deposition \u2013 an unusual case"],"prefix":"10.1590","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-5136","authenticated-orcid":false,"given":"Ana Alves","family":"Oliveira","sequence":"first","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filipa","family":"Pedro","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuno","family":"Craveiro","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Vera","family":"Cruz","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel Sousa","family":"Almeida","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro Pereira","family":"Lu\u00eds","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Santos","sequence":"additional","affiliation":[{"name":"Santar\u00e9m Hospital,  Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2018,8]]},"reference":[{"issue":"6 Pt 2","key":"ref1","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1172\/JCI102205","article-title":"The effect of a cation exchange resin on electrolyte balance and its use in edematous states","volume":"28","author":"Irwin L","year":"1949","journal-title":"J Clin Invest"},{"issue":"5","key":"ref2","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/00000441-195022050-00010","article-title":"Treatment of potassium retention in anuria with cation exchange resin; a preliminary report","volume":"220","author":"Elkinton JR","year":"1950","journal-title":"Am J Med Sci"},{"issue":"6790","key":"ref3","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(53)90465-6","article-title":"Ion-exchange resins in the treatment of anuria","volume":"265","author":"Evans BM","year":"1953","journal-title":"Lancet"},{"issue":"6","key":"ref4","first-page":"432","article-title":"The treatment of hyperkalaemia by carboxylic acid resins in the upper and lower gastrointestinal tract","volume":"80","author":"Palmer RA","year":"1959","journal-title":"Can Med Assoc J"},{"issue":"3","key":"ref5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5380\/rmu.v1i3.40751","article-title":"Resinas trocadoras de c\u00e1tions na hipercalemia aguda grave","volume":"1","author":"Pachaly MA","year":"2014","journal-title":"Rev Med UFPR"},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"264.e9","DOI":"10.1016\/j.amjmed.2012.08.016","article-title":"Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review","volume":"126","author":"Harel Z","year":"2013","journal-title":"Am J Med"},{"issue":"5","key":"ref7","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1681\/ASN.2010010079","article-title":"Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective?","volume":"21","author":"Sterns RH","year":"2010","journal-title":"J Am Soc Nephrol"},{"issue":"5","key":"ref8","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/SMJ.0b013e31819e8978","article-title":"Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol","volume":"102","author":"McGowan CE","year":"2009","journal-title":"South Med J"},{"issue":"3","key":"ref9","first-page":"267","article-title":"Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis","volume":"101","author":"Lillemoe KD","year":"1987","journal-title":"Surgery"},{"issue":"22","key":"ref10","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1056\/NEJMcpc030031","article-title":"Case records of the Massachusetts General Hospital. 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