How to Dissolve Sodium Polystyrene Sulfonate (Kayexalate) Sachet for Pediatric Oral Administration
Suspend each dose in a small quantity of water or syrup at approximately 3 to 4 mL of liquid per gram of resin, prepare the suspension fresh and use within 24 hours, and administer with the patient in an upright position. 1
Preparation Instructions
Mixing Ratio and Technique
- Mix the powder with 3 to 4 mL of liquid per gram of resin to create an appropriate suspension 1
- For a standard 15 g dose, this translates to approximately 45-60 mL of water or syrup 1
- Use either water or syrup as the vehicle for suspension 1
Critical Preparation Guidelines
- Prepare the suspension fresh and discard any unused portion after 24 hours 1
- Never heat the resin as this can alter its exchange properties and reduce effectiveness 1
- Agitate gently to ensure uniform suspension before administration 1
Pediatric Dosing Considerations
Standard Pediatric Dose
- The typical pediatric dose is 1 g/kg up to 15 g (60 mL) every 6 hours as needed for oral administration 2
- One level teaspoon contains approximately 3.5 g of sodium polystyrene sulfonate 1
Critical Safety Warning for Neonates
- Avoid using commercially available liquid preparations in neonates due to hyperosmolar preservative (sorbitol) content 2
- Hospital pharmacies should prepare sorbitol-free preparations for neonatal use 2
- Extremely preterm neonates may develop intestinal hemorrhage (hematochezia) from rectal administration 2
Administration Technique
Patient Positioning
- Always administer with the patient in an upright position to reduce aspiration risk 1
- Patients with impaired gag reflex, altered consciousness, or those prone to regurgitation are at increased risk for aspiration 1
Timing Relative to Other Medications
- Administer at least 3 hours before or 3 hours after other oral medications to prevent binding and reduced drug absorption 1, 3
- Patients with gastroparesis may require a 6-hour separation from other medications 1
- Separate from food by at least 3 hours 3
Critical Safety Considerations
Monitoring Requirements
- Monitor serum potassium during therapy as severe hypokalemia may occur 1
- Monitor calcium and magnesium levels as the resin is not totally selective for potassium 1
- Monitor for constipation (occurs in approximately 8% of patients) and discontinue if it develops 4, 1
Serious Adverse Events
- Intestinal necrosis and other serious gastrointestinal adverse events (bleeding, ischemic colitis, perforation) have been reported, some fatal 1, 5
- Risk factors include prematurity, history of intestinal disease or surgery, hypovolemia, and renal insufficiency 1
- Do not use concomitantly with sorbitol as this significantly increases gastrointestinal toxicity risk 1, 5
Contraindications in Pediatrics
- Contraindicated in neonates with reduced gut motility 1
- Avoid in patients who have not had a bowel movement post-surgery 1
- Do not use for emergency treatment of life-threatening hyperkalemia due to delayed onset of action (several hours) 4, 1
Alternative Considerations
For chronic hyperkalemia management in children, calcium polystyrene sulfonate may be preferred as it avoids additional sodium load, which is particularly important in children with severe hypertension 6