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Indications:

this medicine (calcium polystyrene sulfonate) is indicated in patients with hyperkalemia associated with anuria or severe oliguria. It reduces serum levels of potassium and removes excess potassium from the body. this medicine is indicated in all states of hyperkalemia due to acute and chronic renal failure; examples include use following abortion, complicated labor, incompatible blood transfusion, crush injury, prostatectomy, severe burns, surgical shock, and in cases of severe glomerulonephritis and pyelonephritis. this medicine can also be useful in patients requiring dialysis. Serum potassium levels in acute renal failure often reach dangerous heights before a rise in blood urea indicates the need for hemodialysis. this medicine can be used to reduce these potassium levels and thereby postpone the need for the use of the artificial kidney machine until other causes make it necessary. Patients on regular hemodialysis therapy may develop shunt difficulties and underdialysis occurs, resulting in serious hyperkalemia. In these circumstances it is advisable to give the resin to control hyperkalemia during the period of underdialysis. Monitoring serum potassium and calcium levels should be undertaken at regular intervals. When patients on routine hemodialysis present a dietary management problem and tend towards hyperkalemia, this medicine can be used to control blood potassium levels. Similarly, patients on prolonged peritoneal dialysis may develop intermittent hyperkalemia after a few weeks, possibly due to dietary problems. These patients also can be satisfactorily controlled with this medicine.

Contraindications:

this medicine (calcium polystyrene sulfonate) should not be administered to patients with: C Serum potassium < 5 mmol/litre C Conditions associated with hypercalcemia (e.g. hyperparathyroidism, multiple myeloma, sarcoidosis or metastic carcinoma) C A history of hypersensitivity to polystyrene sulfonate resins C Obstructive bowel disease Oral administration of this medicine is contraindicated in neonates. Administration of the resin in neonates with reduced gut motility (postoperatively or drug induced) is contraindicated.

Adverse reactions:

In accordance with its pharmacological actions, calcium polystyrene sulfonate may give rise to hypokalemia and hypercalcemia and their related clinical manifestations (see Overdosage). Intestinal intolerance due to the gritty consistency and bulk of the resin may be manifested by the appearance of general adverse effects including nausea, vomiting, gastric irritation, anorexia, constipation and occasionally, diarrhea. These adverse effects may be relieved by intermittent therapy and the use of mild laxatives where constipation is a factor. Fecal impaction following rectal administration, particularly in children, and gastrointestinal concretions (bezoars) following oral administration, have been reported. Rarely intestinal obstruction has been reported. This could possibly be a reflection of co-existing pathology or inadequate dilution of the resin. Some cases of acute bronchitis and/or bronchopneumonia associated with inhalation of particles of calcium polystyrene sulfonate have been described. Gastrointestinal tract ulceration or necrosis which could lead to intestinal perforation have been reported following administration of sodium polystyrene sulfonate.

Interactions:

Sorbitol (oral or rectal): Concomitant administration of sorbitol with calcium polystyrene sulfonate is not recommended (see Warnings). To be used with caution: Digitalis: The toxic effects of digitalis on the heart, especially various ventricular arrhythmias and A-V nodal dissociation, are likely to be exaggerated if hypokalemia and/or hypercalcemia develop, even in the face of serum digoxin concentrations in the ‘normal range’ (see this medicine). Cation donating agents: These may reduce effectiveness of the resin in binding potassium. Non-absorbable cation-donating antacids and laxatives: Systemic alkalosis has been reported after cation-exchange resins were administered orally in combination with non-absorbable cation-donating antacids and laxatives such as magnesium hydroxide and aluminum carbonate. Aluminum hydroxide: Intestinal obstruction due to concretions of aluminum hydroxide has been reported when aluminum hydroxide was combined with the resin (sodium form). Lithium: Possible decrease of lithium absorption. Thyroxine: Possible decrease of thyroxine absorption. Pregnancy and lactation: calcium polystyrene sulfonate is not absorbed from the gastrointestinal tract. No data are available about the use of polystyrene sulfonate resins in human pregnancy and lactation.

Warnings:

In neonates, calcium polystyrene sulfonate should not be given by the oral route. Rare instances of colonic necrosis and intestinal obstruction have been reported with sodium polystyrene sulfonate due to concretion formation. This appears to be related to the use of a sorbitol enema with either inadequate or no lavage after use of the resin. 3,4,5 During treatment with Resoniumn calcium (calcium polystyrene sulfonate) the possibility of severe potassium depletion should be considered. Adequate clinical control, as well as biochemical control by daily estimation of serum electrolytes and blood urea levels, is essential during treatment especially in patients on digitalis. To prevent serious hypokalemia administration of the resin should be discontinued as soon as the serum potassium level falls to 5 mmol/L. Hypercalcemia has been reported in well dialysed patients receiving calcium resin,1 and in the occasional patient with chronic renal failure.2 Many patients in chronic renal failure have low serum calcium and high serum phosphate, but some, who cannot be screened out beforehand, show a sudden rise in serum calcium to high levels after therapy with calcium resin. The risk emphasizes the need for adequate biochemical control. Serum calcium levels should be estimated at weekly intervals to detect the early development of hypercalcemia. The dose of administered calcium resin should be reduced to levels at which hypercalcemia and hypokalemia are prevented. 4 Like all cation-exchange resins, calcium polystyrene sulfonate is not totally selective for potassium. Hypomagnesemia and/or hypercalcemia may occur. Accordingly, patients should be monitored for all applicable electrolyte disturbances. In the event of clinically significant constipation, treatment with the resin should be discontinued until normal bowel motions are resumed. Magnesium-containing laxatives should not be used (see Drug Interactions). The patient should be positioned carefully when ingesting the resin, to avoid aspiration, which may lead to bronchopulmonary complications. Children and neonates: In neonates, calcium polystyrene sulfonate should not be given by the oral route. In both children and neonates, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin. Due to the risk of gastrointestinal tract hemorrhage or colonic necrosis, particular care should be observed in premature infants or low birth weight infants.

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