Case of the Month: One Oral Dose of Sodium Polystyrene Sulfonate Associated with Ischemic Colitis and Crystal Deposition in Colonic Mucosa

Ahmed I. Edhi, MD, Mitchell S. Cappell, MD, PhD, Nisha Sharma, MD, et al
ACG Case Rep J 2018;5:e74

Editor’s Commentary: This Case of the Month describes ischemic colopathy secondary to sodium polystyrene sulfonate (SPS) with sorbitol. Sodium polystyrene sulfonate (SPS) with sorbitol, also commonly known as Kayexalate, exchanges sodium ions for potassium ions in the colon, and is a frequently utilized medication for the treatment of hyperkalemia. Secondary to an unclear pathophysiologic mechanism, SPS with sorbitol can induce colonic ulceration and mucosal necrosis, especially in the setting of renal failure and hypovolemia. The diagnosis is confirmed by the presence of angulated, non-polarizable, and basophilic crystals imbedded within colonic mucosa. We chose to highlight this case to increase awareness of this rare but potentially life-threatening complication of a commonly prescribed therapy.

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The ACG Case Reports Journal is a peer-reviewed, open-access journal publishing gastroenterology and hepatology case reports. Edited by GI fellows, it is published online bi-weekly. There are no submission or publication fees for authors.