One Oral Dose of Sodium Polystyrene Sulfonate Associated with Ischemic Colitis and Crystal Deposition in Colonic Mucosa

A 78-year-old-man with chronic mild hypertension, treated with losartan, and uncomplicated, adult-onset diabetes mellitus, treated with metformin, developed increasing abdominal pain associated with serum lactate (6.9 mmol/L) 24 hours after treatment with 30 g orally administered sodium polystyrene sulfonate (SPS) with sorbitol for hyperkalemia (initial potassium 7.3 mmol/L, normal: 3.5-5.2 mmol/L). The patient had presented 1 day earlier with 8 voluminous, watery, non-bloody bowel movements per day for 7 days. Physical examination revealed blood pressure 109/46 mm Hg, pulse 62 beats/minute, temperature 36.4°C, dry mucous membranes, minimal abdominal tenderness, and guaiac-negative stool. Laboratory findings included hemoglobin 11.8 g/dL, leukocytes 12,400 × 106/L, glucose 206 mg/dL, blood urea nitrogen 91 mg/dL, and creatinine 6.6 mg/dL