Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol.
Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol.
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DOI：
10.1097/smj.0b013e31819e8978
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发表时间：
2009-05
影响因子：
1.1
通讯作者：
Moss SF
中科院分区：
文献类型：
--
作者：
McGowan CE;Saha S;Chu G;Resnick MB;Moss SF
聚苯乙烯磺酸钠（SPS，Kayexalate）与肠坏死的发生有关。山梨糖醇，作为一种泻药，可能是主要负责。先前的研究记录了肠坏死主要发生在术后、透析和移植患者中。我们试图确定可能的SPS引起的肠坏死患者的其他临床特征。审查了罗得岛医院的外科病理学记录，以确定1998年12月至2007年6月期间报告含有SPS晶体的所有胃肠道标本。从病历中提取患者人口统计学资料、医学共病和经组织学证实的肠坏死病例的住院病程。确定了29例报告SPS晶体的患者。9例病例因粘膜正常而被排除。9例患者被排除，因为他们的症状开始之前SPS管理或因为肠缺血的替代病因被确定。11例患者证实了肠坏死，并与SPS给药存在时间关系，提示SPS诱导的坏死。仅2例患者术后，仅4例患有终末期肾病（ESRD）。所有患者都有记录的高钾血症，接受口服SPS，并在SPS给药后3小时至11天出现肠损伤症状。四名患者死亡。肠缺血是山梨醇中SPS的公认风险。我们的系列研究强调，即使没有终末期肾病、手术干预或严重合并症，患者也可能易感。
Sodium polystyrene sulfonate (SPS, Kayexalate) has been implicated in the development of intestinal necrosis. Sorbitol, added as a cathartic agent, may be primarily responsible. Previous studies have documented bowel necrosis primarily in postoperative, dialysis, and transplant patients. We sought to identify additional clinical characteristics among patients with probable SPS-induced intestinal necrosis. Rhode Island Hospital surgical pathology records were reviewed to identify all gastrointestinal specimens reported as containing SPS crystals from December 1998 to June 2007. Patient demographics, medical comorbidities, and hospital courses of histologically verified cases of intestinal necrosis were extracted from the medical records. Twenty-nine patients with reports of SPS crystals were identified. Nine cases were excluded as incidental findings with normal mucosa. Nine patients were excluded as their symptoms began before SPS administration or because an alternate etiology for bowel ischemia was identified. Eleven patients had confirmed intestinal necrosis and a temporal relationship with SPS administration suggestive of SPS-induced necrosis. Only 2 patients were postoperative, and only 4 had end-stage renal disease (ESRD). All patients had documented hyperkalemia, received oral SPS, and developed symptoms of intestinal injury between 3 hours and 11 days after SPS administration. Four patients died. Intestinal ischemia is a recognized risk of SPS in sorbitol. Our series highlights that patients may be susceptible even in the absence of ESRD, surgical intervention, or significant comorbidity.