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Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy

BACKGROUND: Sodium polystyrene sulfonate (SPS) is a chelating agent used for the treatment of hyperkalemia. SPS has a wide range of exchange capacity requiring close monitoring of serum electrolytes. We observed two patients who developed acute hypocalcemia and increased metabolic alkalosis after in...

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Autores principales: Kakajiwala, Aadil, Barton, Kevin T., Rampolla, Elisha, Breen, Christine, Pradhan, Madhura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556615/
https://www.ncbi.nlm.nih.gov/pubmed/28959498
http://dx.doi.org/10.1155/2017/6582613
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author Kakajiwala, Aadil
Barton, Kevin T.
Rampolla, Elisha
Breen, Christine
Pradhan, Madhura
author_facet Kakajiwala, Aadil
Barton, Kevin T.
Rampolla, Elisha
Breen, Christine
Pradhan, Madhura
author_sort Kakajiwala, Aadil
collection PubMed
description BACKGROUND: Sodium polystyrene sulfonate (SPS) is a chelating agent used for the treatment of hyperkalemia. SPS has a wide range of exchange capacity requiring close monitoring of serum electrolytes. We observed two patients who developed acute hypocalcemia and increased metabolic alkalosis after initiating SPS therapy. We report these cases to draw attention to the potential risk of this medication in pediatric patients. CASE DIAGNOSIS/TREATMENT: Two children with chronic kidney disease on dialysis were started on SPS for hyperkalemia. Within a week after initiation of the medication, both patients developed hypocalcemia on routine labs without overt clinical manifestations. The hypocalcemia was rapidly corrected with oral supplementation and discontinuation of SPS. CONCLUSIONS: Severe hypocalcemia can develop after SPS therapy. The metabolic alkalosis in these patients associated with the hypocalcemia put them at increased risk for complications. Hence, careful attention must be paid to the state of calcium metabolism in all patients receiving SPS. Often calcium supplementation is required to maintain normal calcium levels.
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spelling pubmed-55566152017-09-28 Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy Kakajiwala, Aadil Barton, Kevin T. Rampolla, Elisha Breen, Christine Pradhan, Madhura Case Rep Nephrol Case Report BACKGROUND: Sodium polystyrene sulfonate (SPS) is a chelating agent used for the treatment of hyperkalemia. SPS has a wide range of exchange capacity requiring close monitoring of serum electrolytes. We observed two patients who developed acute hypocalcemia and increased metabolic alkalosis after initiating SPS therapy. We report these cases to draw attention to the potential risk of this medication in pediatric patients. CASE DIAGNOSIS/TREATMENT: Two children with chronic kidney disease on dialysis were started on SPS for hyperkalemia. Within a week after initiation of the medication, both patients developed hypocalcemia on routine labs without overt clinical manifestations. The hypocalcemia was rapidly corrected with oral supplementation and discontinuation of SPS. CONCLUSIONS: Severe hypocalcemia can develop after SPS therapy. The metabolic alkalosis in these patients associated with the hypocalcemia put them at increased risk for complications. Hence, careful attention must be paid to the state of calcium metabolism in all patients receiving SPS. Often calcium supplementation is required to maintain normal calcium levels. Hindawi 2017 2017-08-01 /pmc/articles/PMC5556615/ /pubmed/28959498 http://dx.doi.org/10.1155/2017/6582613 Text en Copyright © 2017 Aadil Kakajiwala et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Kakajiwala, Aadil
Barton, Kevin T.
Rampolla, Elisha
Breen, Christine
Pradhan, Madhura
Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title_full Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title_fullStr Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title_full_unstemmed Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title_short Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
title_sort acute hypocalcemia and metabolic alkalosis in children on cation-exchange resin therapy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556615/
https://www.ncbi.nlm.nih.gov/pubmed/28959498
http://dx.doi.org/10.1155/2017/6582613
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