Maximum Dosage of Kayexalate in 24 Hours
The maximum dose of Kayexalate (sodium polystyrene sulfonate) in 24 hours is 60 grams for adults, typically administered as 15 gram doses one to four times daily. 1
Dosing Guidelines
The FDA-approved labeling provides clear guidance on Kayexalate dosing:
Oral administration:
- Average total daily adult dose: 15-60 grams
- Typical dosing pattern: 15 grams (four level teaspoons) 1-4 times daily
- Each dose should be suspended in 3-4 mL of liquid per gram of resin 1
Rectal administration:
- Average adult dose: 30-50 grams every 6 hours 1
- Administered as a warm emulsion in 100 mL of aqueous vehicle
- Should be flushed with 50-100 mL of fluid
Important Administration Considerations
- Prepare suspension fresh and use within 24 hours
- Do not heat Kayexalate as it could alter the exchange properties of the resin
- One level teaspoon contains approximately 3.5 grams of Kayexalate and 15 mEq of sodium 1
- Administer with patient in an upright position to reduce risk of aspiration
- Administer at least 3 hours before or 3 hours after other oral medications (6 hours for patients with gastroparesis) 1
Safety Considerations and Warnings
Sodium Content
- Each 15 gram dose contains 1,500 mg (60 mEq) of sodium
- Monitor patients sensitive to sodium intake (heart failure, hypertension, edema) for signs of fluid overload 1
Serious Adverse Effects
- Cases of intestinal necrosis, some fatal, have been reported with Kayexalate use 1, 2
- Risk factors for gastrointestinal adverse events include:
- Prematurity
- History of intestinal disease or surgery
- Hypovolemia
- Renal insufficiency and failure 1
Contraindications
Kayexalate is contraindicated in patients with:
- Hypersensitivity to polystyrene sulfonate resins
- Obstructive bowel disease
- Neonates with reduced gut motility 1
Monitoring Requirements
- Monitor serum potassium during therapy as severe hypokalemia may occur
- Monitor calcium and magnesium levels as small amounts can be lost during treatment 1
- Discontinue use in patients who develop constipation
Special Populations
For pediatric patients, particularly extremely preterm neonates, there is risk of intestinal hemorrhage (hematochezia) from rectal Kayexalate 3. The FDA labeling does not specify a maximum pediatric dose, suggesting the need for careful clinical judgment in this population.
Remember that Kayexalate should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 1. Alternative treatments should be considered in urgent situations.