Kalimate @ Calcium Polystyrene Sulfonate - Dosing & Administration

Reference	Product Leaflet (Kalimate Powder - Kowa Co ltd, Tokyo, Japan)	UptoDate: Calcium polystyrene sulfonate: Drug information	BNF 76 & BNFC (2018-2019)
Indication	Hyperkalaemia resulting from acute or chronic renal failure	Hyperkalemia: Initiate treatment if potassium level >6 mmol/L (6 mEq/L); discontinue when potassium ≤5 mmol/L (5 mEq/L).	Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients
Oral Dosage	Daily dosage is 15-30 g, to be taken divding into 2-3 times. The dosage should be adjusted according to patient's condition.	Usual dose: 15 g 3 to 4 times daily; dose should be based on clinical presentation and serum electrolyte levels Oral administration in neonates is contraindicated.	15 g, 3-4 times daily Child: 0.5–1 g/kg daily in divided doses; maximum 60 g per day
Oral Admini-stration Instruction	Each dose should be suspended in 30-50 mL of water and administered orally.	Administer orally (via nasogastric tube if unable to swallow) at least 3 hours before or 3 hours after other oral medications (patients with gastroparesis may require a 6 hour separation) as a prepared suspension or paste. Patient should be positioned carefully during ingestion to avoid aspiration.
Rectal Dosage	-	30 g once daily	Neonate: 0.5–1 g/kg daily, irrigate colon to remove resin after 8–12 hours. Child: Same as neonate; maximum 30 g per day
Rectal Admini-stration Instruction	·   A single dose of 30 g should be suspended in 100 mL water (or 5% glucose solution or 2% methylcellulose solution) and administered via the rectal route after warming to body temperature. It should be left in the intestinal tract for 30-60 minutes after administration.  ·   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. ·   Following retention of the enema, the colon should be irrigated to remove the resin.	·   Administer rectally as a prepared suspension. ·   Enema should be retained as long as possible (product labeling suggests for at least 9 hours in adults or as long as possible) as greater amounts of potassium are excreted as retention time increases. ·   Follow enema with irrigation to remove resin.	·   30 g, retained for 9 hours followed by irrigation to remove resin from colon ·   With rectal use Mix each 30 g of resin with 150mL of water or 10% glucose. OR Mix each 1 g of resin with 5mL of water or 10% glucose.

Note: (UptoDate)

• o   More rapid lowering of potassium may be achieved with concomitant oral and rectal administration. Rectal route may be discontinued once orally administered resin has reached rectum. 
• o   Enema route is less effective than oral administration.