ASK DIS: Administration of Kalimate

Availability: calcium polystyrene sulfonate 5g/sachet

Indication: Adults

Indication: Children and neonates:

In neonates, RESONIUM CALCIUM should not be given by the oral route
In both children and neonates, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin.
Due to the risk of gastrointestinal tract hemorrhage or colonic necrosis, particular care should be observed in premature infants or low birth weight infants.

Adminstration : General

Oral or rectal administration only
Treatment with the resin should be given as soon as the serum potassium level rises above 6 mmol/L (23.5 mg per 100 mL).
The action may be delayed for one or two days since maximal exchange probably takes place in the colon.
Exchange will continue until all the resin has been voided (this may be one or two days after administration has been discontinued).
resin therapy should be stopped when the serum potassium level has fallen to 5 mmol/L, otherwise, the continued action may lead to potassium depletion.
precise daily dose should be decided on the basis of regular clinical and serum electrolyte determination.
The amount of potassium taken up by the resin will be largely determined by the length of time it is exposed to the high potassium concentration in the fecal water in the colon.
For this reason, a tendency towards constipation should be encouraged and purgative drugs should be avoided.

Oral: Adult

usual dose is 15 g, 3 or 4 times a day.
given by mouth as a suspension in a little water, or for greater palatability, the resin may be made into a paste with some sweetened vehicle, but not orange juice or other fruit juices that are known to contain potassium.
The amount of fluid usually ranges from 3 to 4 mL per gram of resin.
If there is difficulty with swallowing, it may be given through a gastric tube, 2 to 3 mm in diameter

Oral: Children

by using as a guide a rate of 1mEq of potassium per gram of resin as the basis for calculation.
Children should be given 1 g/kg body weight of RESONIUM CALCIUM daily in divided doses, in acute hyperkalemia.
In maintenance therapy the dose may be reduced to 0.5 g/kg body weight daily in divided doses.
Frank Shann: 0.3-0.6g/kg QID NG (+ lactulose) PR
When given orally, preferably with a drink or a little jam or honey
It should not be given in fruit drinks and some carbonated beverages, since these have a high potassium content

Rectal: Adult

given rectally as a suspension of 30 g resin in 100 mL of 2% methylcellulose or 100 mL of water, as a daily retention enema.
It should be left in the intestinal tract for at least 30 min to 1 hour
In case the suspension leaks out, the hip should be lifted up by placing a pillow underneath or the patient should be sit on the knee-chest position.
5% glucose solution may be substituted for the water
In the initial stages, administration by this route as well as orally may help to achieve a more rapid lowering of the serum potassium level.
Since the rectal route is less effective than the oral route, the longer the resin is retained the greater is the amount of potassium removed.
The enema should, if possible, be retained for at least nine hours and then the colon irrigated to remove the resin.
If both routes are used initially, it is probably unnecessary to continue rectal administration once the oral resin has reached the rectum

Rectal: Children

given rectally suspended in a proportional amount of 10% dextrose in water.
Following retention of the enema, the colon should be irrigated to ensure adequate removal of the resin

Rectal: Neonate

Oral administration is contraindicated in neonates.
Administration of the resin in neonates with reduced gut motility (postoperatively or drug-induced) is contraindicated
Only rectal administration should be considered.
With rectal administration, the minimum effective dosage within the range of 0.5 g/kg to 1 g/kg should be employed, diluted as for adults and with adequate irrigation to ensure recovery of the resin

Refererences:

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