Development of Colonic Perforation during Calcium Polystyrene Sulfonate Administration: A Case Report

A 90-year-old female complaining of severe upper abdominal pain was transferred to our institution. The patient had been prescribed with calcium polystyrene sulfonate (CPS) for the treatment of hyperkalemia following myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) associated glomerulonephritis. Physical examination revealed diffuse tenderness over the abdomen, with signs of peritoneal irritation. Abdominal computed tomography (CT) revealed the retention of ascites, free air in the abdominal cavity, and the retention of hard stools in the left-sided colon. The diagnosis of intestinal perforation was immediately confirmed; thereafter, the patient underwent emergency surgical treatment. Surgical findings revealed a perforated site in the descending colon surrounded with hard stools. Histopathology of the perforated colon revealed crystalline materials, suggestive of association with CPS. CPS is a cation-exchange resin used to treat hyperkalemia; the major adverse effect in patients receiving CPS is constipation. When CPS is administered to patients with frequent constipation or the elderly, the risk of intestinal perforation should be considered. 1. Introduction Calcium polystyrene sulfonate (CPS) is a cation-exchange resin widely used in the treatment of hyperkalemia associated with acute or chronic renal failure; however, the major side effect of CPS is constipation. Here we describe the case of a 90-year-old female who presented with colonic perforation during CPS administration. 2. Case Presentation A 90-year-old female complaining of severe upper abdominal pain was transferred to our institution in December 2012. The patient’s history included angina pectoris, which was treated using coronary stents and dual antiplatelet therapy. The patient was treated with hemodialysis for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) associated glomerulonephritis and had been receiving CPS (ARGAMATE) for the treatment of hyperkalemia. On admission, the patient was confirmed to be in shock with the following signs: blood pressure, 77/55？mm？Hg; heart rate, 82 beats/min; body temperature, 36.5°C; oxygen saturation, 92% on room air. On clinical examination, her weight, height, and body mass index were 40.6？kg, 139？cm, and 20.9？kg/m2, respectively. Inspection of the palpebral conjunctiva revealed evidence of severe anemia. Chest auscultation revealed no evidence of abnormal heart murmurs and no rales or other lung sounds. The abdomen revealed diffuse tenderness, with signs of peritoneal irritation. Physical examination revealed whole body