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Reader Remarks on:

Is Kayexalate Effective for Hyperkalemia, and Is It Safe?

• Another droperidol?
• other methods to lower potassium levels
• Review less than helpful
• SPS Old Time Religion

Another droperidol?

Erik Deede, 11 Jun 2010 10:43 PM EST

Competing interests: None declared

My understanding is that the other treatments you mentioned for lowering serum potassium (insulin/dextrose, inhaled beta-2 agonist, and sodium bicarbonate) just temporarily shift potassium into the cells. Won't the serum potassium just rebound to the same level once those wear off? Don't you need something that actually removes potassium from the body? Do you know how common this colonic necrosis is? This seems similar to the droperidol black-box warning from a few years ago- a few case reports of a complication despite millions and millions of uses render a treatment option medicolegally risky.

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other methods to lower potassium levels

Cynthia D. Owens, 15 Jun 2010 1:09 AM EST

Competing interests: None declared

I agree. The other modalities available to treat hyperkalemia has variable peak effects and duration effects, which at best last for only 20 -30 miins. Thus multiple modalities are needed to treat this process. It would be beneficial to be informed of the number needed to treat to see this adverse effect.

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Review less than helpful

Paul L Hacker, 15 Jun 2010 9:34 PM EST

Competing interests: None declared

I agree with the other commentators - this review is less than helpful. The absence of evidence is not the same as the absence of efficacy. Hopefully an RCT can be mustered to provide better guidance.

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SPS Old Time Religion

Clyde H Sharpley, Hospital, 18 Aug 2010 2:26 AM EST

Competing interests: None declared

You tell any Doctor that has been using something they think works, that it actually doesn't work, there will be disagreement. Fact is most of the use of SPS is worthless; it is just something we do automatically. It only has a little benefit after potassium has been lowered by other means. You don't give SPS as an emergency solution, but to prevent elevations later. K can be controlled by other means which do last more than 15min. SPS also exchanges one meq of K+ for 1 meq of Na+.

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