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kayexalate-associated colitis

Saturday 9 March 2019

Kayexalate-induced colonic ulcer


Sodium polystyrene sulfonate (Kayexalate) is an ion exchange resin that binds intraluminal potassium; it can cause ischemia and intestinal necrosis, especially (but not only) if given with sorbitol (Am J Surg Pathol 1997;21:60).

Kayexalate is a cation-exchange resin that acts in the large intestine by exchanging sodium ions for potassium ions. It is used in the treatment of hyperkalemia and can be administered orally or as an enema.

The mechanism of mucosal damage is not clear, and reported to be more common in patients with uremia. It is speculated that it is caused by its osmotic action and vasospasm of the intestinal vasculature.

Some studies have suggested that Kayexalate in sorbitol may be associated with intestinal necrosis and inflammation in uremic patients.

Abraham and colleagues focused on endoscopic and histological findings in patients with Kayexalate crystals from upper gastrointestinal biopsies.

Kayexalate-induced intestinal injury reveals rhomboid or triangular basophilic crystals adherent to the surface epithelium.

Kayexalate can be a cause of lower gastrointestinal mucosal injury and ulceration with no evidence of necrosis, as confirmed histologically by evidence of Kayexalate crystalline resin in a patient with end-stage renal disease.


- Kayexalate-associated mucosal injury
- Kayexalate: bright purple crystals with fish scale appearance.
- Kayexalate-induced colonic ulcer

See also

- pill-associated colitis

Open references


Paywall references

- Parfitt JR, Driman DK. Pathological effects of drugs on the gastrointestinal tract: a review. Hum Pathol. 2007;38:527–36.

- Gardiner GW. Kayexalate (sodium polystyrene sulphonate) in sorbitol associated with intestinal necrosis in uremic patients. Can J Gastroenterol. 1997;11:573–77.

- Rashid A, Hamilton SR. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an under-recognized condition. Am J Surg Pathol. 1997;21:60–69.

- Abraham SC, Bhagavan BS, Lee LA, et al. Upper gastrointestinal tract injury in patients receiving Kayexalate (sodium polystyrene sulfonate) in sorbitol: clinical, endoscopic, and histopathologic findings. Am J Surg Pathol. 2001;25:637–44.

- Schiere S, Karrenbeld A, Tulleken JE, et al. Sodium polystyrene sulfonate (resonium a) as possible cause of rectal blood loss. Ned Tijdschr Geneeskd. 1997;141:2127–29.