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  • Perinatal/Neonatal Case Presentation
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Perinatal/Neonatal Case Presentation

Necrotizing enterocolitis in a 850 gram infant receiving sorbitol-free sodium polystyrene sulfonate (Kayexalate): clinical and histopathologic findings

Journal of Perinatology volume 27, pages 247–249 (2007)Cite this article

Abstract

We report a 27-week, 850 g infant with severe Streptococcus group B sepsis and life-threatening hyperkalemia due to progressive anuria. On the fourth day of life, after he failed treatment with diuretics, salbutamol, insulin, calcium gluconate and sodium bicarbonate, he was treated with sorbitol-free Kayexalate enemas. Potassium level slowly decreased from 9.2 mmol/l to normal level along with a recovery of normal urine output. On the 11th day of life, clinical and radiological signs of a perforated necrotizing enterocolitis (NEC) occurred and the patient required surgical intestinal resection. Histologic examination of the ileum specimen revealed areas of necrosis with fibrosis and giant cell reaction to a nonpolarizable material consistent with sodium polystyrene sulfonate. Usually, Kayexalate is suspended in hyperosmolar sorbitol solutions and the elevated osmolarity seems to be responsible for hemorrhagic colitis, transmural necrosis and definitely NEC. Our case report shows that Kayexalate per se, and not necessarily suspended in sorbitol, can lead to gastrointestinal tract complications and NEC in preterm infants.

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References

  1. Chandler JC, Hebra A . Necrotizing enterocolitis in infants with very low birth weight. Semin Pediatr Surg 2000; 9: 63.

    Article  CAS  Google Scholar 

  2. Scherr L, Ogden DA, Mead AW, Spritz N, Rubin AL . Management of hyperkalemia with a cation-exchange resin. N Engl J Med 1961; 264: 115–119.

    Article  CAS  Google Scholar 

  3. Bennett LN, Myers TF, Lambert GH . Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram infant with hyperkalemia. Am J Perinatol 1996; 13: 167–170.

    Article  CAS  Google Scholar 

  4. Milley JR, Jung AL . Hematochezia associated with the use of hypertonic sodium polystyrene sulfonate enemas in premature infants. J Perinatol 1995; 15: 139–142.

    CAS  PubMed  Google Scholar 

  5. Chlumska A, Boudova L, Pavlovsky M, Sulc M . Intestinal necrosis following Calcium Resonium-sorbitol administration in a premature uraemic infant. Cesk Patol 2002; 38: 169–172.

    CAS  PubMed  Google Scholar 

  6. Grammatikopoulos T, Greenough A, Pallidis C, Davenport M . Benefits and risks of calcium resonium therapy in hyperkalaemic preterm infants. Acta Paediatr 2003; 92: 118–120.

    Article  CAS  Google Scholar 

  7. Lin PW, Simmonds CF . Fluid and electrolyte management In: Cloherty JP, Eichenwald EC, Stark AR (eds). Manual of Neonatal Care. Lippincott Williams & Wilkins: Philadelphia, 2004, p 111.

    Google Scholar 

  8. Menke JA, Stallworth RE, Binstadt DH, Strana AJ, Wallace SE . Medication bezoar in a neonate. Am J Dis Child 1982; 136: 72–73.

    CAS  PubMed  Google Scholar 

  9. Metlay LA, Klionsky BL . An unusual gastric bezoar in a newborn: polystyrene resin and Candida albicans. J Pediatr 1983; 102: 121–123.

    Article  CAS  Google Scholar 

  10. Ohlsson A, Hosking M . Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Ped 1987; 146: 571–574.

    Article  CAS  Google Scholar 

  11. Sherman S, Friedman AP, Berdon WE, Haller JO . Kayexalate: a new cause of neonatal bowel opacification. Radiology 1981; 138: 63–64.

    Article  CAS  Google Scholar 

  12. Wootton FT, Rhodes DF, Lee WM, Fitts CT . Colonic necrosis with Kayexalate-sorbitol enemas after renal transplantation. Ann Intern Med 1989; 111: 947–949.

    Article  CAS  Google Scholar 

  13. Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM . Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery 1987; 101: 267–272.

    CAS  PubMed  Google Scholar 

  14. Abraham SC, Bhagavan BS, Lee LA, Rashid A, Wu TT . Upper gastrointestinal tract injury in patients receiving Kayexalate (sodium polystyrene sulfonate) in sorbitol. Am J Surg Pathol 2001; 25: 637–644.

    Article  CAS  Google Scholar 

  15. Filippi L, Cecchi A, Dani C, Bertini G, Pezzati M, Rubaltelli FF . Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns. Paediatr Anaesth 2004; 14: 271–275.

    Article  Google Scholar 

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Acknowledgements

Financial disclosure: no financial support has been provided for this study, and there was no financial or competing interest by any of the authors in the subject matter.

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Authors and Affiliations

  1. Department of Pediatrics, Neonatal Intensive Care Unit, University of Verona, Verona, Italy

    S Rugolotto, M Gruber, P D Solano & L Chini

  2. Department of Pathology, University of Verona, Verona, Italy

    S Gobbo & S Pecori

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  1. S Rugolotto
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  2. M Gruber
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  4. L Chini
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Correspondence to S Rugolotto.

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Rugolotto, S., Gruber, M., Solano, P. et al. Necrotizing enterocolitis in a 850 gram infant receiving sorbitol-free sodium polystyrene sulfonate (Kayexalate): clinical and histopathologic findings. J Perinatol 27, 247–249 (2007). https://doi.org/10.1038/sj.jp.7211677

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