Hyperkalaemia – Calcium Resonium
Calcium Resonium
A Review on the role of this drug in Acute Hyperkalaemia
(1) ‘There is Dubious Evidence for the use of this Drug‘
– Original Evidence for Calcium Resonium was in the 1960s (see below).
– The resin was invented in the 1950s for industrial purposes and then someone had the idea of putting it in patients colons to exchange cations and hence bind potassium (mostly absorbed in the colon).
Scherr et al (NEJM) – http://www.ncbi.nlm.nih.gov/pubmed/13747532
– This paper did show a drop in K
– In the study there were 32 patients
– They had Binding Resin +/- a laxative,
– Most patients had glucose, insulin, low K diet and bicarbonate therapy
– THERE WAS NO CONTROL GROUP
– In the end in this study 23 /30 patients had a decrease of at least 0.4 in their K value… This was cited as evidence of effectiveness
– However, there was NO CONTROL GROUP and a lot of HCO3 and Insulin was used
A second paper in the same journal – http://www.ncbi.nlm.nih.gov/pubmed/13700297 also studied the use of binding resins
– There were 10 patients in the study
– 5 got sorbitol and 5 got the Calcium Resonium binding resin plus sorbitol
– All got a low K diet –they was continued for 5 days
– The authors then measured the potassium once at 5 days
– Findings? – patients who got the laxative had LOWER K after the 5 days of the study than the patients that got Resonium
(2) It may be ‘Ineffective’
– Since the 1960s studies referred to above, further investigations into the efficacy of Calcium Resonium in treating hyperkalaemia have been limited.
– One small study (http://www.ncbi.nlm.nih.gov/pubmed/9773794) in 1998 showed no change in serum potassium concentration after a single dose of binding resin or placebo (both with and without a sorbitol additive)
– They concluded – “Because single-dose resin-cathartic therapy produces no or only trivial reductions in serum potassium concentration, and because this therapy is unpleasant and occasionally is associated with serious complications, this study questions the wisdom of its use in the management of acute hyperkalaemic episodes.”
– There was also a study that measured stool K suggesting it didn’t work
(3) Harm when the ‘resin is given alone’ without a cathartic
– Multiple Case Reports of Harm… (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776612)
(4) Renal Literature
– Recent moves away from use in some circles – http://www.ncbi.nlm.nih.gov/pubmed/20167700?dopt=AbstractPlus
“It would be wise to exhaust other alternatives for managing hyperkalaemia before turning to these largely unproven and potentially harmful therapies.”
(5) Excellent Audio Summary
– For the Audio Clip
http://media.blubrry.com/emcrit/p/traffic.libsyn.com/emcrit/EMCrit-Bonus-Kayexalate-Useless.mp3
(6) Update on HyperK Management
http://www.onthewards.org/pods/83-hyperkalaemia
(7) ECG Page
https://emergencypedia.com/ecg/
EmergencyPedia 