Drugs not used for treatment of acute hyperkalemia-

The cation exchange resin sodium polystyrene sulfonate (SPS) exchanges Na+ for K+ in the gastrointestinal tract and increases the fecal excretion of K The onset of action is unpredictable and usually takes a few hours. One of the major side effects of SPS in sorbitol is colonic necrosis associated with increased morbidity and moality. SPS can cause constipation, so it is usually given with a cathaic agent, such as sorbitol. (increased risk of necrosis) The low but real risk of intestinal necrosis with SPS, which can sometimes be the only available or appropriate therapy for the removal of potassium, must be weighed against the delayed onset of efficacy. Whenever possible, alternative therapies for the acute managementof hyperkalemia (i.e., aggressive redistributive therapy,isotonic bicarbonate infusion, diuretics, and/or hemodialysis) should be used instead of SPS. (reference: harrisons principles of internal medicine,19E , page 312)