Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.


We no longer use sodium polystyrene sulfonate (Kayexalate) since it can result in the formation of concretions.


  • treatment of hyperkalemia


  • removes potassium from the body by exchanging sodium ions for potassium, particularly in the large intestine; potassium-containing resin is then excreted; small amounts of other cations such as calcium and magnesium may be lost during treatment: sodium retention may occur
  • 1 g of resin binds approximately 1 mmol (1 mEq) of K+
  • reduction of serum potassium level occurs within 2 to 24 hours

Side Effects

  • hypokalemia, hypocalcemia, hypomagnesemia, sodium retention, vomiting, constipation
  • may cause fecal impaction


  • monitor serum potassium, sodium, calcium, and magnesium
  • observe for hypokalemia - irritability, muscle pain and weakness, dampened T-wave on ECG
  • watch bowel function, check daily


  • calculated on exchange rate of 1 mmol of potassium per gram of resin: usual dose is 1 g/kg per rectum q2-6h
  • rectal: mix powders with 5-10 mL of sterile water and give as an enema using a 10 mL syringe and 5 Fr. feeding tube; deliver at a rate of 1 mL/kg/min
  • pinch buttocks while withdrawing tubing and for 3 to 5 minutes after


  • 1 g powders stocked in the unit
  • other weights of powders prepared by Pharmacy as needed


  1. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  2. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  3. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
  4. Taeusch WH Ballard RA and Avery ME (ed): Schaffer and Avery's Diseases of the Newborn, WB Saunders Co, Toronto, Ontario; 6th Edition, 1991.

Last Uploaded: Thursday, 26-May-2011 00:53:47 EDT