Resonium (Polystyrene Sulfonate) Dosing for Hyperkalemia
The standard dose of polystyrene sulfonate (Resonium) for treating hyperkalemia is 15 g orally 1-4 times daily (15-60 g/day) or 30-50 g rectally every 6 hours. 1
Dosing Regimens and Expected Potassium Reduction
Oral Administration
- 15 g oral dose: Reduces serum potassium by approximately 0.39 mEq/L
- 30 g oral dose: Reduces serum potassium by approximately 0.69 mEq/L
- 60 g oral dose: Reduces serum potassium by approximately 0.91 mEq/L 2, 1
Rectal Administration
- 30 g rectal dose: Reduces serum potassium by approximately 0.22 mEq/L 2, 1
- Should be administered with the patient in a vertical position
- Suspended in a small amount of water or syrup (3-4 ml of liquid per gram of resin) 1
Administration Guidelines
- Oral doses should be suspended in water or syrup
- Administer with patient in upright position
- Separate from other oral medications by at least 3 hours (6 hours in patients with gastroparesis) 1
- For rectal administration, retain the enema for as long as possible
Clinical Considerations
Severity-Based Dosing
- Mild hyperkalemia (K+ 5.0-5.5 mEq/L): 15-30 g oral dose
- Moderate hyperkalemia (K+ 5.5-6.0 mEq/L): 30-60 g oral dose
- Severe hyperkalemia (K+ >6.0 mEq/L): 60 g oral dose or 30-50 g rectal dose, along with other rapid-acting interventions 1, 3
Important Limitations
- Onset of action: Variable and delayed (hours to days), making it unsuitable for emergency treatment of life-threatening hyperkalemia 1
- For emergency treatment: Other rapid-acting interventions like insulin with glucose, inhaled beta-agonists, or calcium administration are more appropriate 3
Monitoring and Safety Considerations
- Monitor serum potassium levels during treatment to avoid hypokalemia
- Also monitor calcium and magnesium levels (medication can bind these cations) 1
- Contains significant sodium (100 mg per 100g of powder), which may be problematic in patients with hypertension or heart failure 1
Contraindications and Precautions
- Hypersensitivity to polystyrene sulfonate resins
- Intestinal obstruction
- Use with caution in patients with:
- Constipation or risk of fecal impaction
- History of intestinal surgery
- Inflammatory bowel disease
- Ischemic colitis
- Intestinal vascular atherosclerosis 1
Adverse Effects
- Serious gastrointestinal adverse events have been reported, including intestinal necrosis, bleeding, perforation, and ischemic colitis
- Hypokalemia, hypocalcemia, and hypomagnesemia can occur with excessive use 1
For chronic or recurrent hyperkalemia in patients on RAAS inhibitors, daily low-dose SPS may be considered as a preventive measure, but newer potassium binders (patiromer, sodium zirconium cyclosilicate) have better efficacy and safety profiles 3, 1.