How is sodium polystyrene sulfonate (SPS) used in the treatment of hyperkalemia (high serum potassium level)?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Gastrointestinal (GI) excretion can be increased through the use of cation exchange resins such as sodium polystyrene sulfonate (SPS). SPS can be administered orally or rectally (as a retention enema). Because the major site of action for this drug is the colon, rectal administration is preferred for hyperkalemic emergencies. The effectiveness of SPS is enhanced if the enema can be retained for 1 hour.

SPS is not useful for acute control of hyperkalemia, because its effect on potassium is delayed for at least 2 hours, peaking at 4-6 hours. SPS can decrease serum potassium by 2 mEq/L.

Oral SPS is useful in patients with advanced renal failure who are not yet on dialysis or transplant candidates. One or more daily doses of 15 g can control mild to moderate hyperkalemia effectively, with little inconvenience to patients.

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