Is sodium polystyrene sulfonate (SPS) a safe and effective treatment in patients with 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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Although SPS has a long history of use for hyperkalemia, its safety and efficacy have been questioned. [66, 69, 70, 63] The US Food and Drug Administration (FDA) advises against its use in patients who do not have normal bowel function (eg, postoperative patients who have not had a bowel movement since their procedure) or those who are at risk for constipation or impaction. [71] SPS should be discontinued in patients who become constipated, and repeat doses should not be given to patients who have not passed a bowel movement.

In addition, the FDA cautions that giving SPS with sorbitol, an osmotic cathartic used to prevent fecal impaction from SPS and to speed delivery of resin to the colon, has been associated with cases of intestinal necrosis, some of them fatal. [71] Current evidence indicates that this serious side effect can occur with SPS even when preparation does not contain any sorbitol. [72]

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