Monday Pharmaceutical Mystery: September 23

JC is a female patients, age 55 years, on peritoneal dialysis at home. She presents to the pharmacy to pick up 2 new medications: Patiromer 8.4 g orally once daily Lactulose 20 grams tid, JC is a female patients, age 55 years, on peritoneal dialysis at home. She presents to the pharmacy to pick up 2 new medications:

Patiromer 8.4 g orally once daily

Lactulose 20 grams, 3 times a day

Other medications on file:

Amlodipine 5 mg orally once daily

Sodium polystyrene sulfonate in sorbitol 60ml x 1 bottle, 4 times a week

Calcium carbonate 1250mg bid

Calcitriol 0.25 mcg/day

Oxycodone 5/325 1-2 q4h prn, for severe abdominal pain

As you give her the medications, you ask her how she is doing and if she has any questions regarding her medications.

She opens up to you and says she was recently discharged from the hospital after having bowel surgery. You recall she had received several opioid prescriptions prior to her hospitalization for abdominal pain. You ask her if her pain is better and she says ‘yes.’ It is completely resolved since they did the bowel resection and removed 12 inches of necrotic intestines.

Mystery: What caused the abdominal pain that lead to the bowel resection? (Hint: it was caused by a pharmaceutical)

Solution: Sodium polystyrene sulfonate in sorbitol induced intestinal necrosis.

Reference

McGowan CE, Saha S, Chu G, Resnick MB, Moss SF. Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol. South Med J. 2009;102(5):493—497. doi:10.1097/SMJ.0b013e31819e8978