Rectal ulcer due to Kayexalate deposition - an unusual case

SUMMARY Sodium polystyrene sulfonate (PSP) or Kayexalate is a cation-exchange resin, widely used in the management of hyperkalaemia due to renal disease. A rare, yet potentially dangerous, adverse event related to sodium polystyrene sulfonate use is intestinal mucosal injury, especially in the colon. The injury to the gastrointestinal mucosa can range from mild and superficial to wall necrosis and bowel perforation. The mechanism that leads to mucosal damage remains unclear. However, it is believed that sorbitol, commonly given to counteract PSP's tendency to cause constipation, may play an important role in the development of gastrointestinal injury. Other potential risk factors are uraemia or end-stage renal disease, hemodynamic instability, solid organ transplantation, postoperative status and concomitant opioid administration. The authors present a case of diarrhoea and haematochezia after the administration of PSP without sorbitol, in a patient with hyperkalaemia due to acute kidney injury, in the absence of other risk factors. A colonoscopy was performed and revealed a rectal ulcer which histological findings were suggestive of mucosal injury due to Kayexalate deposition. This case supports the concept that this widely used drug can itself, without sorbitol, cause injury to the gastrointestinal wall. Even though this is a rare adverse effect, the widespread use of this medication may put a large population at risk.

RESUMO O polistireno sulfonato de sódio (PSP) ou kayexalato é uma resina de troca iônica, amplamente usada no tratamento da hipercalemia associada à doença renal. Um efeito adverso raro, mas potencialmente grave, dessa terapêutica é a agressão à parede do trato gastrointestinal, principalmente ao nível do cólon, que pode ser ligeira e superficial ou culminar em necrose e perfuração intestinal. O mecanismo pelo qual o PSP lesa a mucosa intestinal não é totalmente conhecido. Contudo, pensa-se que o sorbitol, frequentemente administrado em simultâneo para contrabalançar o efeito obstipante do PSP, possa ter um papel preponderante no desenvolvimento de lesão gastrointestinal. Outros potenciais fatores de risco são a presença de uremia ou doença renal em estágio terminal, instabilidade hemodinâmica, pós-operatório, pós-transplante renal e a administração concomitante de opioides. Os autores descrevem um caso de diarreia e hematoquesias após a administração de PSP sem sorbitol, numa paciente com hipercalemia secundária a lesão renal aguda, sem outros fatores de risco para o desenvolvimento desse efeito adverso. A investigação etiológica com colonoscopia revelou a presença de uma úlcera retal, cujo estudo histológico foi compatível com lesão por deposição de cristais de kayexalato. Este relato incomum reforça o conceito de que este fármaco de uso frequente, mesmo na ausência de sorbitol, pode ser lesivo para a mucosa intestinal. Assim, e apesar de este ser um efeito adverso raro, a utilização difundida do PSP coloca uma vasta população em risco.

Taste masking of ofloxacin and formation of interpenetrating polymer network beads for sustained release / 药物分析学报

The objective of this study was to carry out taste masking of ofloxacin (Ofl) by ion exchange resins (IERs) followed by sustained release of Ofl by forming interpenetrating polymer network (IPN) beads. Drug-resin complexes (DRCs) with three different ratios of Ofl to IERs (1:1, 1:2, 1:4) were prepared by batch method and investigated for in vivo and in vitro taste masking. DRC of methacrylic acid-divinyl benzene (MD) resin and Ofl prepared at a ratio of 1:4 was used to form IPN beads. IPN beads of MD 1:4 were prepared by following the ionic cross-linking method using sodium carboxymethyl xanthan gum (SCMXG) and SCMXG-sodium carboxymethyl cellulose (SCMXG-SCMC). IPN beads were characterized with FT-IR and further studied on sustained release of Ofl at different pH. In vivo taste masking carried out by human volunteers showed that MD 1:4 significantly reduced the bitterness of Ofl. Characterization studies such as FT-IR, DSC, P-XRD and taste masking showed that complex formation took place between drug and resin. In vitro study at gastric pH showed complete release of drug from MD 1:4 within 30 min whereas IPN beads took 5 h at gastric pH and 10 h at salivary pH for the complete release of drug. As the crosslinking increased the release kinetics changed into non-Fickian diffusion to zero-order release mechanism. MD 1:4 showed better performance for the taste masking of Ofl and IPNs beads prepared from it were found useful for the sustained release of Ofl at both the pH, indicating a versatile drug delivery system.

Elaboración de una biorresina intercambiadora de cationes a partir de cáscara de plátano o guineo para eliminar metales pesados en agua contaminada / Preparation of a cation exchanger bioresin start from banana peel or guineo to remove heavy metals in polluted water

Esta investigación tuvo por objetivo obtener una bio-resina intercambiadora de cationes utilizando cáscaras de guineo o plátano, la cual reduzca la concentración de metales pesados en agua contaminada. A esta bio-resina se le realizaron pruebas fisicoquímicas: densidad seca aparente, pH y solubilidad en agua y solventes orgánicos. Se evaluó su efectividad filtrando agua contaminada con metales pesados, tales como hierro, cromo y níquel (Fe3+, Cr6+ y Ni2+), variando las condiciones de tiempo de contacto, temperatura y el tipo de cáscara. La cuantificación de la concentración de los metales en el agua filtrada se llevó a cabo por espectrofotometría visible. Se llegó a la conclusión que la bio-resina obtenida es efectiva para disminuir la concentración de metales pesados en agua, teniendo especial afinidad química por el cromo hexavalente; metal pesado que logró remover arriba del 90%. Las condiciones óptimas de operación de la bio-resina son a 30°C y 90 minutos de tiempo de contacto con la muestra. Además, las pruebas fisicoquímicas, permitieron tipificarla preliminarmente como una resina de intercambio catiónico débil con un grado de entrecruzamiento bajo.

This research aimed to obtain a cation exchange bio-resin, using plantain or banana peels, that reduces the concentration of heavy metals in contaminated water. The bio-resin underwent physico-chemical tests like apparent dry density, pH, solubility in water and organic solvents. Its effectiveness was tested by filtering contaminated water with heavy metals such as iron, chromium and nickel (Fe3+, Cr6+ y Ni2+) and by varying contact time conditions, temperature and type of peel. The measure of concentration of metals in filtered water was taken through visible spectrophotometry. We concluded that the resulting bio-resin is effective in reducing the concentration of heavy metals in water, showing special chemical affinity with hexavalent chromium, a heavy metal that was able to remove above 90%. The bio-resin optimum working conditions are 30°C and 90 minutes of contact with the sample. Also, the physico-chemical tests allowed to preliminary typify it as a weak cation exchange resin with a low degree of crosslinking.

Novel ion exchange resin-based combination drug-delivery system for treatment of gastro esophageal reflux diseases

The present study involves preparation and characterization of a combination tablet of ranitidine in immediate release form and domperidone in sustained release form, using ion exchange resins. Ranitidine lowers acid secretion, while domperidone release over a prolonged period improves gastric motility thus justifying this combination in gastro esophageal reflux diseases (GERD) and ensuring patient compliance. Drug loading was carried out by batch method & resinates were characterized using FTIR, XRPD. Resinates were formulated as a combination tablet and evaluated for tablet properties & in vitro drug release. Resinates provided sustained release of domperidone and immediate release of ranitidine. IR and X-ray studies indicate complexation of drug and resin along with monomolecular distribution of drugs in amorphous form in the resin matrix. The tablets of resinate combination showed good tablet properties. In-vitro drug release gave desired release profiles and ex-vivo drug absorption studies carried out by placing everted rat intestine in dissolution medium indicated statistically significant similarity in absorption from test and marketed formulation. The novelty of this study is that the retardation in release of domperidone from resinates is achieved by presence of weak resin in the formulation.

O presente estudo envolve a preparação e a caracterização de associação do comprimido de ranitidina de liberação imediata e domperidona de liberação prolongada, utilizando resinas de troca iônica. A ranitidina diminui a secreção ácida, enquanto a liberação prolongada de domperidona melhora a motilidade gástica, justificando, dessa forma, a associação em doenças de refluxo gastroesofágico (DRGE) e garantindo a adesão do paciente. A carga de fármaco foi efetuada pelo método em batelada e os resinatos, caracterizados utilizando-se FTIR e XRPD. Os resinatos foram formulados como comprimido da associação e avaliados com relação às propriedades dos comprimidos e liberação do fármaco in vitro. Os resinatos proporcionaram a liberação prolongada da domperidona e a liberação imediata da ranitidina. IV e estudos de difração de raios X indicaram a complexação do fármaco e da resina junto com a distribuição monomolecular dos fármacos, em estado amorfo, na matriz da resina. Os comprimidos da associação do resinato apresentaram boas propriedades. Obtiveram-se os perfis de liberação in vitro e os estudos de absorção dos fármacos ex vivo realizados com intestino de rato em meio de dissolução indicaram semelhança significativa na absorção entre as formulações teste e comercializada. A inovação do trabalho é que o retardamento da liberação da domperidona dos resinatos é atingido pela presença de resina fraca na formulação.

The application of HA330-Ⅱ microporous resin plasma adsorption in the treatment of chronic severe hepatitis / 中国基层医药

Objective The aim of the study is to discuss the application value of HA330-Ⅱ microporous resin plasma adsorption in liver support and the treatment of complications of chronic severe hepatitis.Methods The treatment group has 41 patients of chronic severe hepatitis B,which were treated for 3 times by HA330-Ⅱ microporous resin plasma adsorption.We compared the improvement of symptom,the fadeamay and rebound of icterus,the change of hepatic encepllalOpathy and brain oedema,the change of blood routine test,blood ammonia level,blood-gas analyzing result,cruor index,inflammatory factors(IL-1b,IL-6,IL-8,TNF-α,etc.),side effects,etc.The control group has 37 patients of the same type.Results HA330-Ⅱ microporous resin plasma adsorptioin is partly effective for the improvement of symptom,improvernent rate 43.9%,and without new discomfort due to the treatment. It obtains some extent fadeaway of icterus which has a low rebound,reduce TBiL(17.83±3.65)% and there be no statistics difference of rebound.It lowers the blood ammonia level and improves the hepatic encephalopathy and brain oedema.It absorbs cytokine IL-8.Atthough it has some extent effect to albunfin,blood paltelet,haemoglobin.Conclusion HA330-Ⅱ microporous resin plasma adsorption has good application value in the treatment of chronic severe hepatitis B.It is a new treatment choice of severe hepatitis.

The Application of Macroreticular Resins to Concentrate Organic Contaminants in Water / 环境与健康杂志

Concentration of the trace organic contaminants in water by high adsorption capacity macroreticular resins, have been introduced to physical, chemical and biological analysis of organic compounds from surface water, underground water, tap water and different kinds of wastewaters, and runoff water. This review summarized the techniques and conditions for the application of macroreticular resins to concentrate the organic compounds in water, including purification of resin, column preparation, solvents extraction and elution, concentration of eluate and resin regeneration. It is suggested that it is necessary to set the technique criteria for the application of macroreticular resins.