title: Special comments - Neonatal Intensive Care Drug Manual
text: Efficacy
  A Cochrane review identified 2 small randomised trials evaluating the Kayexalate in comparison with glucose-insulin and albuterol infusions in preterm infants with hyperkalaemia. RCT by Malone et. al. enrolled 12 preterm infants ≤ 28 weeks GA. Sodium polystyrene sulfonate (Kayexalate) was prepared in 25% sorbitol and administered rectally 1 g/kg every 6 hours in 5 infants and glucose-insulin infusion was administered in 7 infants. All 5 infants treated with Kayexalate had an increase in serum K+ concentration of more than 0.5 mmol/L within the first 6 hours of treatment, and treatment was considered to have failed. Hu et. al., enrolled 40 VLBW infants with non-oliguric hyperkalaemia and randomly divided them into insulin (RI) infusion group and Kayexalate group. In Kayexalate group (n=20), the dose of Kayexalate was 1g/kg body weight given rectally every four hours. The duration of hyperkalaemia in RI group was significantly shorter in comparison to Kayexalate group. The incidence of grade II and above intraventricular haemorrhage (IVH) was significantly low in RI group (15% vs 50%). Sample sizes of the trials in this meta-analysis were very small to make any firm recommendations in clinical practice, but insulin and glucose infusion and albuterol infusion were found to be safer and more effective in comparison to cation exchange resin. (1, 3-5)
  Safety
  Gastrointestinal haemorrhage and intestinal perforation and necrosis have been reported. (6-10) Sorbitol used for Resonium enema preparation have been implicated for these complications. Incidence of ≥ grade 2 intraventricular haemorrhage was higher in Kayexalate group in comparison to glucose-insulin treated infants. (3)
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