Intestinal necrosis after co‐administration of sodium polyst
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The development of acute abdominal pain after Kayexalate and activated charcoal administration should prompt a clinician to consider intestinal necrosis. Concomitant use should be avoided to minimize the risk of this devastating but preventable condition.

A 30‐year‐old man presented to the emergency department after ingesting several pills of penicillin, sertraline, and zaleplon with intent to commit suicide. He denied any shortness of breath, fever, abdominal pain, or change in bowel habits at the time of presentation. His past medical history was significant for end‐stage renal disease secondary to streptococcal glomerulonephritis and five kidney transplants secondary to allograft rejection. He received activated charcoal initially for gastric lavage and sodium polystyrene sulfonate (aka Kayexalate) for hyperkalemia and developed colonic necrosis. This case raises awareness of this rare complication by concomitant use of both activated charcoal and Kayexalate.

The exact mechanism of colonic necrosis is not well known but hypovolemia, hyperreninemia, elevated prostaglandin production, and localized colonic mesenteric vasospasm have all been suggested. The actual occurrence of colonic necrosis and other related colonic complications is also not well known. Some studies showed the incidence of intestinal necrosis was 0.27% and 1.8% in uremic and postoperative patients, respectively. Most symptoms were seen between 3 hours and 11 days of Kayexalate administration. Few cases of upper GI tract complications like gastric and duodenal ulcers have also been reported. Rarely, small bowel necrosis is also seen with SPS administration requiring small bowel resection. To the best of knowledge, this case is a first reported case of a patient who received AC and SPS concomitantly.

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