Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol - An underrecognized condition
Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol - An underrecognized condition
复制标题
DOI：
10.1097/00000478-199701000-00007
复制
发表时间：
1997-01-01
影响因子：
5.6
通讯作者：
Hamilton, SR
中科院分区：
文献类型：
--
作者：
Rashid, A;Hamilton, SR
据报道，山梨醇中的聚苯乙烯磺酸钠（Kayexalate）以灌肠或口服方式治疗高钾血症会诱发尿毒症患者肠坏死。我们研究了 15 名患者的临床和病理特征，这些患者在胃肠道手术切除 (n = 9) 或内窥镜活检 (n = 7) 的标本中观察到 Kayexalate 晶体。据记录，10 名患者通过口服或鼻胃管服用山梨糖醇中的 Kayexalate。在 12 名患者的结直肠标本中，有 9 名患者（75%）观察到坏死，其中 8 名手术切除标本中的 7 名和 5 名内镜活检标本中的 3 名代表。在 7 名患者中，除了山梨醇中的 Kayexalate 之外，没有其他明显的结直肠坏死原因，其中 4 名患者还出现小肠坏死。 4 名初次切除标本中出现结肠坏死的患者出现小肠或直肠进行性坏死，5 名患者 (56%) 在 1 天至 6 周内出现致命结果。在四名患者的上胃肠道标本中观察到了聚苯乙烯磺酸盐晶体，其中一名患者患有出血性胃炎。我们的研究结果提供了额外的证据，证明口服或通过鼻胃管施用的山梨醇中的 Kayexalate 可以在胃肠道中产生坏死。
Sodium polystyrene sulfonate (Kayexalate) in sorbitol given as an enema or orally to treat hyperkalemia has been reported to induce intestinal necrosis in uremic patients. We studied the clinical and pathologic features of 15 patients in whom Kayexalate crystals were observed in specimens from gastrointestinal surgical resections (n = 9) or endoscopic biopsies (n = 7). Oral or nasogastric tube administration of Kayexalate in sorbitol was documented in 10 patients. Among 12 patients with colorectal specimens, necrosis was observed in nine patients (75%), represented by seven of eight surgical resection specimens and three of five endoscopic biopsy specimens. No other cause of colorectal necrosis apart from Kayexalate in sorbitol was apparent in seven patients, and four also had necrosis of the small intestine. Four patients with colonic necrosis in their initial resection specimen developed progressive necrosis of the small intestine or rectum, and five patients (56%) had fatal outcome within 1 day to 6 weeks. Kayexalate crystals were observed in upper gastrointestinal tract specimens from four patients, including one with hemorrhagic gastritis. Our findings provide additional evidence thar Kayexalate in sorbitol administered orally or by nasogastric tube can produce necrosis in the gastrointestinal tract.