Kayexalate for constipation?

[cappuccinespresso]

I was reading my patient's drug orders, one of her PRN meds is Kayexalate, and the doctor states on the orders that it is to be given for her constipation. Now this confuses me, because I read in my book that one of Kayexalate's common side effects IS constipation. She's on bowel protocol, which means she's already having trouble with her bowel movements as it is; shouldn't the Kayexalate be removed from her PRNs? Or is there another reason why the drug would be given for constipation? Her K levels pre-clinical are within normal range.

Would love it if anyone can give me an idea of why it was ordered that way, or if the doctor made a mistake. Thanks

[nurseprnRN, BSN, RN]

I have no idea why he would be doing this, unless he remembers from his med school days that it used to be mixed in sorbitol, which can loosen just about anybody's bowels. I'd call and ask him, particularly in view of the following (from rxlist.com)

Kayexalate (sodium polystyrene) may cause some degree of gastric irritation. Anorexia,nausea, vomiting, and constipation may occur especially if high doses are given. Also,hypokalemia, hypocalcemia, hypomagnesemia and significant sodium retention, and their related clinical manifestations, may occur (see WARNINGS). Occasionally diarrhea develops. Large doses in elderly individuals may cause fecal impaction (seePRECAUTIONS). Rare instances of intestinal necrosis have been reported. Intestinal obstruction due to concretions of aluminum hydroxide, when used in combination with Kayexalate (sodium polystyrene) , has been reported.

The following events have been reported from worldwide post marketing experience:

• Fecal impaction following rectal administration, particularly in children;
  
• Gastrointestinal concretions (bezoars) following oral administration;
  
• Ischemic colitis, gastrointestinal tract ulceration or necrosis which could lead to intestinal perforation; and,
  
• Rare cases of acute bronchitis and/or broncho-pneumonia associated with inhalation of particles of polystyrene sulfonate.
  

[Nursing_Mamacita]

Question the order!

In my experience, doctors tend to forget to D/C orders frequently.

More important than her BMs is her K levels. If they are normal and she is receiving Kayexalate, they won't be normal for long. Definitely want to avoid that hypokalemia.

Keep us posted!

And good thinking