How long does oral Kayexalate continue to work in the body?

morte, LPN, LVN · Mar 21, 2013

It is not metabolized nor absorbed. action is entirely in the gut. Interesting patient...perhaps they need insulin instead of kayexalate?

Esme12, ASN, BSN, RN · Mar 21, 2013

Morte is right....is isn't absorbed and is excreted in the GI tract....some sources say it isn't effective at all.

Pharmacology . https://online.epocrates.com/u/10a1840/Kayexalate

Metabolism: none; CYP450: none; Info: no systemic absorption

Excretion: feces; Half-life: unknown; Info: cationically changed resin is excreted

Subclass: Electrolytes

Mechanism of Action

exchanges sodium for potassium ions

What else was going on with this patient? What other meds were they on? What are the other labs? I need more information to help you.

hodgieRN · Mar 21, 2013

Also depends on where or not pts have bowel movements. If they start passing stool, that's when it's most effective. Although, the loss of potassium via stool probably has more effectiveness than Kayexalate itself (but the stool would have to be diarrhea). But, kayexalate usually causes diarrhea. If not, then the nurse is jumping for joy. Something else had to be going on.

meglp17 · Mar 21, 2013

Thanks for the input everyone :) Here's what I remember about the patient: They were in metabolic acidosis, diabetic, nephrologist had them on a sodium bicarbonate drip, K of 6.4, they received kayexalate (I don't remember any other labs). Three days later the critical labs were K- 2.0, Ca- 5.7, glucose-42; and yes the patient had diarrhea.

hodgieRN · Mar 22, 2013

That's why the potassium dropped. He was on a bicarb gtt. It's not from the kayexalate. Bicarb gtts are notorious for dropping K. Bicarb causes potassium to shift out of the serum and into the cell. Giving someone bicarb is actually a treatment for hyperkalemia. If they are on a gtt, it continuous shifting. Usually, you should check the K level often. The bicarb gtt was there to treat the metabolic acidosis, but depending on how much bicarb is infusing, you should check it every 12-24 hrs. If they have 150 meq in a bag and it's infusing at 200ml/hr, I would check it every 6-8. Yes, the diarrhea added to the K loss, but the bicarb gtt is the guilty party.

morte, LPN, LVN · Mar 22, 2013

Hyperkalemia Management sometimes I surprise myself!

meglp17 · Mar 22, 2013

He hadn't had labs drawn for over 48 hours. Sodium bicarbonate was infusing at 125ml/hr. I went home for the night right as these critical values were called to the day nurse, so I didn't get to see what happened later on in the day with the patient. This was the first experience I've had with a bicarb drip, so thanks for all the input!

hodgieRN · Mar 22, 2013

No problem! A little IV K and some IV calcium and the pt's good to go.

Vespertinas · Mar 22, 2013

This can't be right. K of 6.4, bicarb gtt, and no labs for >48h?

Or maybe it is... jeez I don't know anymore. My head spins when I hear some of this stuff.

morte, LPN, LVN · Mar 22, 2013

especially if, as I suspect, the patient also got insulin and glucose.....

This can't be right. K of 6.4, bicarb gtt, and no labs for >48h?
Or maybe it is... jeez I don't know anymore. My head spins when I hear some of this stuff.

ron27 · Oct 21, 2013

how come you left a hyperkalemic patient who is being treated without labs for more than 24 hours.. geeezzzzzzz