Cite this post as:
Scott Weingart, MD FCCM. Bonus – Is Kayexalate Useless?. EMCrit Blog. Published on March 22, 2011. Accessed on January 26th 2022. Available at [https://emcrit.org/emcrit/is-kayexalate-useless/ ].
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Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.
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I love the revisiting of topics that we all take for granted on a daily basis. Kudos to Dr. Moayedi for turning on the light in an unused bedroom.
Great review and I agree with everything said. It’s amazing that our practice is based on those poorly conducted studies. That being said, I can’t imagine I can stare at a potassium of 8.6 and not give kayexalate. Has anyone actually not given it?
I have not had the courage yet, Rahul.
I RARELY give it. I see no benefit and many potential harms.
If the inpatient team really wants it, they can order it.
If the renal guys are insistent and on their way with HD, then I order it but make no effort to make sure it happens. Usually the 15g I order never is given anyway. And 15g isn’t much.
HH
Scott,
I enjoyed the kayexalate talk, but if I remember correctly, it was focused on hyperkalemic patients going (eventually) to dialysis. This is not generally the patients that I see. It’s not clear to me that kayexalate is “bad” for the more typical patient with, say, a K of 6.6, maybe some EKG changes, but not a dialysis patient, and unlikely to go to dialysis. Would you still forego the kayexalate on these folks?
Thanks.
Michael,
I think this is a very good point and I’ll tell you, I don’t know quite how to process this kayexalate stuff yet.
This is a very interesting discussion! I don’t think it matters if the patient is a dialysis patient or not. In the setting of hyperkalemia the patient generally either has a reversible cause for hyperK or else they are going to dialysis anyways. Examples of reversible causes would be some causes of acute renal failure, DKA, adrenal crisis, medication with K sparing diuretic, etc. In all of these cases you are either going to be able to fix the underlying problem, or the patient is going to go to dialysis anyways. Since we have effective therapies to treat hyperkalemia acutely… Read more »
good sense indeed! I wish someone would do a head to head kayexylate to lactulose.
Can u speak a little more re dog toxicity and ca? Levine a article as retrospective chart review leaves me un impressed with wushu washy conclusion that maybe it’s safe
Can u speak a little more re dog toxicity and ca? Levine a article as retrospective chart review leaves me un impressed with wushu washy conclusion that maybe it’s safe
all I can tell you is that there is no credible evidence of harm