Calcium Polystyrene Sulfonate is indicated for the management of hyperkalemia, particularly in patients with anuria or severe oliguria. It helps lower elevated serum potassium levels by removing excess potassium from the body. It is effective in hyperkalemia associated with acute and chronic renal failure, complications of blood transfusion, severe tissue injury, major burns, surgical shock, and severe infections such as glomerulonephritis and pyelonephritis. This medication is also useful in patients undergoing dialysis and may be administered during dialysis to help control potassium levels.

Calcium Polystyrene Sulfonate acts throughout the gastrointestinal tract by exchanging calcium ions for potassium ions. The bound potassium is then eliminated through the feces. As the drug passes through the colon, it interacts with potassium-rich fluids, resulting in increased removal of potassium from the body. The duration of its presence in the body significantly influences its effectiveness. Oral administration is generally more effective than rectal administration due to prolonged contact time within the gastrointestinal tract.

Calcium Polystyrene Sulfonate is for oral or rectal administration only. Treatment with the resin should be given as soon as the serum potassium level rises above 6 mmol/L.

Adults (Including the Elderly)-

• Oral: For adults the usual dose is 15 g, 3 or 4 times a day. The resin is given by mouth as a suspension in a little water or for greater palatability, the resin may be made into a paste with some sweetened vehicle but not orange juice or other fruit juices that are known to contain potassium. The amount of fluid usually ranges from 3 to 4 ml for per gram of resin.
• Rectal: In cases where oral administration is not possible Calcium Polystyrene Sulfonate may be given rectally as a suspension of 30 g resin in 100 ml of 2% methylcellulose and 100 ml of water as a daily retention enema.

Pediatrics-

• Oral: Children should be given 1 g/kg body weight of Calcium Polystyrene Sulfonate daily in divided doses in acute hyperkalemia. In maintenance therapy the dose may be reduced to 0.5 g/kg body weight daily in divided doses.
• Rectal: It can be given rectally suspended in a proportional amount of 10% dextrose in water. Following retention of the enema, the colon should be irrigated to ensure adequate removal of the resin.

Neonates-

• Oral administration of Calcium Polystyrene Sulfonate is contraindicated in neonates.
• Only rectal administration should be considered. With rectal administration, the minimum effective dosage within the range of 0.5 g/kg to 1 g/kg should be given diluted as for adults and with adequate irrigation to ensure recovery of the resin.

Concomitant use of Calcium Polystyrene Sulfonate is not recommended with sorbitol, digitalis preparations, cation-donating agents, non-absorbable cation-exchange antacids or laxatives, aluminum hydroxide, lithium, and thyroxine.

Calcium Polystyrene Sulfonate should not be used in patients with serum potassium levels below 5 mmol/L or in conditions associated with hypercalcemia such as hyperparathyroidism, multiple myeloma, sarcoidosis, or metastatic carcinoma. It is also contraindicated in patients with known hypersensitivity to polystyrene sulfonate resins and in those with obstructive bowel disease. Oral administration is contraindicated in neonates.

Possible adverse effects include nausea, vomiting, gastric irritation, anorexia, constipation, and occasionally diarrhea. Other reported effects include fecal impaction, gastrointestinal narrowing or obstruction, ischemia, ischemic colitis, rectal bleeding, and gastrointestinal ulceration or necrosis. Electrolyte disturbances such as hypomagnesemia and hypercalcemia may occur. Rare cases of acute bronchitis and bronchopneumonia have also been reported.

Calcium Polystyrene Sulfonate is not systemically absorbed from the gastrointestinal tract. However, there is insufficient data regarding its safety during pregnancy and lactation.

During treatment, there is a risk of excessive potassium depletion. Therapy should be discontinued once serum potassium falls to approximately 5 mmol/L to avoid severe hypokalemia. Electrolyte levels should be monitored regularly. If significant constipation occurs, treatment should be paused until normal bowel function returns. Magnesium-containing laxatives should be avoided. Proper patient positioning is necessary during administration to prevent aspiration and possible respiratory complications.

Children and neonates: Oral use is not recommended. In these populations, rectal administration should be performed with extreme caution.

Symptoms of overdose may include signs of hypokalemia such as irritability, confusion, delayed thinking, muscle weakness, reduced reflexes, and possible paralysis. Severe cases may lead to apnea. Electrocardiographic changes may reflect hypokalemia or hypercalcemia, and cardiac arrhythmias may occur.

Hyperkalaemia Products

Store below 30°C in a dry place, protected from light. Keep out of reach of children.