rt, especially various ventricular arrhythmias and a-v nodal dissociation, are likely to be exaggerated by hypokalemia, even in the face of serum digoxin concentrations in the "normal range". (see warnings .) sorbitol concomitant use of sorbitol with sodium polystyrene sulfonate for suspension has been implicated in cases of intestinal necrosis, which may be fatal. therefore, concomitant administration is not recommended. (see warnings .) lithium sodium polystyrene sulfonate for suspension may decrease absorption of lithium. thyroxine sodium polystyrene sulfonate for suspension may decrease absorption of thyroxine. carcinogenesis, mutagenesis, impairment of fertility studies have not been performed. pregnancy category c animal reproduction studies have not been conducted with sodium polystyrene sulfonate for suspension. it is also not known whether sodium polystyrene sulfonate for suspension can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. sodium polystyrene sulfonate for suspension should be given to a pregnant woman only if clearly needed. nursing mothers it is not known whether this drug is excreted in human milk. because many drugs are excreted in human milk, caution should be exercised when sodium polystyrene sulfonate for suspension is administered to a nursing woman. pediatric use the effectiveness of sodium polystyrene sulfonate for suspension in pediatric patients has not been established. in neonates, sodium polystyrene sulfonate for suspension should not be given by the oral route. in both children and neonates particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin. due to the risk of digestive hemorrhage or intestinal necrosis, particular care should be observed in premature infants or low birth weight infants.

or bowel obstruction). discontinue use in patients who develop constipation. alternative therapy in severe hyperkalemia since effective lowering of serum potassium with sodium polystyrene sulfonate for suspension may take hours to days, treatment with this drug alone may be insufficient to rapidly correct severe hyperkalemia associated with states of rapid tissue breakdown (e.g., burns and renal failure) or hyperkalemia so marked as to constitute a medical emergency. therefore, other definitive measures, including dialysis, should always be considered and may be imperative. hypokalemia serious potassium deficiency can occur from therapy with sodium polystyrene sulfonate for suspension. the effect must be carefully controlled by frequent serum potassium determinations within each 24 hour period. since intracellular potassium deficiency is not always reflected by serum potassium levels, the level at which treatment with sodium polystyrene sulfonate for suspension should be discontinued must be determined individually for each patient. important aids in making this determination are the patient's clinical condition and electrocardiogram. early clinical signs of severe hypokalemia include a pattern of irritable confusion and delayed thought processes. electrocardiographically, severe hypokalemia is often associated with a lengthened q-t interval, widening, flattening, or inversion of the t wave, and prominent u waves. also, cardiac arrhythmias may occur, such as premature atrial, nodal, and ventricular contractions, and supraventricular and ventricular tachycardias. the toxic effects of digitalis are likely to be exaggerated. marked hypokalemia can also be manifested by severe muscle weakness, at times extending into frank paralysis. electrolyte disturbances like all cation-exchange resins, sodium polystyrene sulfonate for suspension is not totally selective (for potassium) in its actions, and small amounts of other cations such as magnesium and calcium can also be lost during treatment. accordingly, patients receiving sodium polystyrene sulfonate for suspension should be monitored for all applicable electrolyte disturbances. systemic alkalosis systemic alkalosis has been reported after cation-exchange resins were administered orally in combination with nonabsorbable cation-donating antacids and laxatives such as magnesium hydroxide and aluminum carbonate. magnesium hydroxide should not be administered with sodium polystyrene sulfonate for suspension. one case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene sulfonate for suspension with magnesium hydroxide as laxative. (see precautions, drug interactions .)

nsion in a small quantity of water or, for greater palatability, in syrup. the amount of fluid usually ranges from 20 ml to 100 ml, depending on the dose, or may be simply determined by allowing 3 ml to 4 ml per gram of resin. healthcare professionals should follow full aspiration precautions when administering this product, such as placing and maintaining the patient in an upright position while the resin is being administered. the resin may be introduced into the stomach through a plastic tube and, if desired, mixed with a diet appropriate for a patient in renal failure. the resin may also be given, although with less effective results, in an enema consisting (for adults) of 30 g to 50 g every six hours. each dose is administered as a warm emulsion (at body temperature) in 100 ml of aqueous vehicle. the emulsion should be agitated gently during administration. the enema should be retained as long as possible and followed by a cleansing enema. after an initial cleansing enema, a soft, large size (french 28) rubber tube is inserted into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon, and taped in place. the resin is then suspended in the appropriate amount of aqueous vehicle at body temperature and introduced by gravity, while the particles are kept in suspension by stirring. the suspension is flushed with 50 ml or 100 ml of fluid, following which the tube is clamped and left in place. if back leakage occurs, the hips are elevated on pillows or a knee-chest position is taken temporarily. a somewhat thicker suspension may be used, but care should be taken that no paste is formed, because the latter has a greatly reduced exchange surface and will be particularly ineffective if deposited in the rectal ampulla. the suspension is kept in the sigmoid colon for several hours, if possible. then, the colon is irrigated with nonsodium containing solution at body temperature in order to remove the resin. two quarts of flushing solution may be necessary. the returns are drained constantly through a y tube connection. while the use of sorbitol is not recommended, particular attention should be paid to this cleansing enema if sorbitol has been used. the intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. sodium polystyrene sulfonate for suspension should not be heated for to do so may alter the exchange properties of the resin.

perforation; and, rare cases of acute bronchitis and/or broncho-pneumonia associated with inhalation of particles of polystyrene sulfonate.

rt, especially various ventricular arrhythmias and a-v nodal dissociation, are likely to be exaggerated by hypokalemia, even in the face of serum digoxin concentrations in the "normal range". (see warnings .) sorbitol concomitant use of sorbitol with sodium polystyrene sulfonate for suspension has been implicated in cases of intestinal necrosis, which may be fatal. therefore, concomitant administration is not recommended. (see warnings .) lithium sodium polystyrene sulfonate for suspension may decrease absorption of lithium. thyroxine sodium polystyrene sulfonate for suspension may decrease absorption of thyroxine. carcinogenesis, mutagenesis, impairment of fertility studies have not been performed. pregnancy category c animal reproduction studies have not been conducted with sodium polystyrene sulfonate for suspension. it is also not known whether sodium polystyrene sulfonate for suspension can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. sodium polystyrene sulfonate for suspension should be given to a pregnant woman only if clearly needed. nursing mothers it is not known whether this drug is excreted in human milk. because many drugs are excreted in human milk, caution should be exercised when sodium polystyrene sulfonate for suspension is administered to a nursing woman. pediatric use the effectiveness of sodium polystyrene sulfonate for suspension in pediatric patients has not been established. in neonates, sodium polystyrene sulfonate for suspension should not be given by the oral route. in both children and neonates particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin. due to the risk of digestive hemorrhage or intestinal necrosis, particular care should be observed in premature infants or low birth weight infants.