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Drug dosage identifier

Sodium polystyrene sulphonate

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Dose and administration

Rectal: 0.5 - 1.0 gm/kg every 20 minutes PRN, have infant retain dose for 15-20 minutes.

Indication

Hyperkalaemia (as an adjunct to other therapeutic measures).

Contraindications and precautions

  1. Hypernatraemia
  2. Congestive heart failure
  3. Caution in neonates with hypokalaemia and hypocalcaemia.

Clinical pharmacology

Sodium polystyrene sulphonate is a cation-exchange resin prepared in the sodium phase with an in vivo exchange capacity of approximately 1 mmol of potassium per gm. As the resin passes along the intestine or is retained in the colon, the sodium ions are partially released and are replaced by potassium ions. For the most part this action occurs in the large intestine which excretes potassium ions to a greater degree than does the small intestine. The resin is not totally selective: potassium and small amounts of other cations such as magnesium and calcium can be lost during treatment. Treatment is slow with effective lowering of serum potassium taking hours to days.

Possible adverse effects

  1. Gastrointestinal disturbances (nausea, vomiting, constipation, diarrhoea).
  2. Hypokalaemia
  3. Hypocalcaemia
  4. Other electrolyte disturbances.

Special considerations

  1. Sodium content 100 mg/gm.
  2. Administration with sorbitol facilitates passage through GI tract, prevents constipation.
  3. For severe hyperkalaemia (>7.5 mmol/L) consider emergency therapy such as IV glucose and insulin or IV sodium bicarbonate.
  4. Monitor serum electrolytes for hypernatraemia, hypokalaemia, hypocalcaemia.

Management of Sodium Polystyrene Sulphonate administration

Description

  • Light brown to brown finely ground powder.
  • Dispensed on individual prescription by Pharmacy.

Prescription

Charted on the stat page of the prescription chart in grams/dose.

Administration

Rectal

  1. Mix each gram in 4 ml of water/glycerine. Do NOT heat mixture prior to administration. May change exchange properties.
  2. Administer via an 8 Fr. feeding tube.
  3. Insert 2.5-3.5cm into rectum.
  4. Elevate hips during administration. May need to hold buttocks together so body retains enema for approximately 20 minutes.

Observation and documentation

  1. Monitor for signs of adverse effects.
  2. Monitor fluid balance.

Storage

Powder at room temperature <25°C.

Selected references

  1. Greaney M, Saunders R (eds). NE Compendium: Detailed prescribing information. Auckland, Adis Press 1990; p902.
  2. Pawlak RP, Hertfert LAT. Drug administration in the NICU. 2nd Ed 1991. Neonatal Network p248-249.

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Document Control

  • Date last published: 28 February 1997
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years