Unusual ileus due to calcium polystyrene sulfonate
Journal
Postgraduate Medical Journal
Journal Volume
92
Journal Issue
1091
Pages
563
Date Issued
2016
Author(s)
Abstract
A 62-year-old man with a history of coronary artery disease, hypertension and diabetes mellitus was admitted to a respiratory care unit for chronic respiratory failure after an episode of life-threatening myocardial infarction. The hospital course was complicated with presumed intra-abdominal infection with the presentation of fever, abdominal pain and muscle guarding. An emergent non-contrast CT of the abdomen and pelvis showed much faecal material with high density in the small and large intestines (figure 1, arrows) and resultant bowel loop dilation, compatible with ileus (figure 2, lung window, arrows). The cause of the high-density faecal material was due to retained calcium polystyrene sulfonate for potassium removal, which was noted as homogenously high-density substance in the stomach (figure 1, arrowheads). His constipation and ileus improved after aggressive laxatives, and his fever subsided gradually under intravenous antibiotics for possible bacterial translocation. Cation-exchange resin is routinely used to treat hyperkalemia in daily practice. Sodium polystyrene sulfonate, the most commonly used resin, is associated with colonic necrosis or other fatal gastrointestinal injury.1 Although rare, calcium polystyrene sulfonate still has the potential risk of severe gastrointestinal complication.2 In this case, calcium polystyrene sulfonate via nasogastric tube was diffusely retained in the gastrointestinal tract, causing severe ileus and resultant abdominal sepsis. Physicians should be aware of these possible gastrointestinal adverse events when prescribing cation-exchange resin for hyperkalemia.
SDGs
Other Subjects
antibiotic agent; laxative; polystyrenesulfonate calcium; chelating agent; polystyrene derivative; polystyrenesulfonic acid; abdominal infection; abdominal pain; adult; Article; case report; chronic respiratory failure; constipation; coronary artery disease; diabetes mellitus; fever; heart infarction; human; hyperkalemia; hypertension; ileus; male; medical history; middle aged; sepsis; chemically induced; constipation; diagnostic imaging; ileus; x-ray computed tomography; Chelating Agents; Constipation; Humans; Ileus; Male; Middle Aged; Polystyrenes; Tomography, X-Ray Computed
Publisher
BMJ Publishing Group
Type
journal article