Other nonneoplastic
Kayexalate damage

Topic Completed: 1 December 2012

Minor changes: 15 February 2019

Copyright: 2003-2019,, Inc.

PubMed Search: Kayexalate damage

Elliot Weisenberg, M.D.
Page views in 2019: 648
Page views in 2020 to date: 647
Cite this page: Weisenberg E. Kayexalate damage. website. Accessed August 10th, 2020.
Definition / general
  • Kayexalate (sodium polystyrene sulfonate) in sorbitol is used to treat hyperkalemia
  • Symptoms are from sorbitol, given orally though NG tube or as an enema, may crystallize in esophagus, stomach or duodenum and produce endoscopic ulcers and erosions resembling carcinoma or Candida (Am J Surg Pathol 2001;25:637)
  • Colonic infarction and erosions reported
Case reports
Microscopic (histologic) description
  • Crystals are lightly basophilic with a faint crystalline mosaic pattern, better seen with PAS / Alcian blue
  • Crystals are refractile but not polarizable, luminal and adherent to intact surface epithelium or mixed with inflammatory exudate in patients with ulcer or erosion
Microscopic (histologic) images

Contributed by Dr. Ankur Sangoi

Various images

AFB stain

Board review style question #1
Which of the following microscopically identifiable medication materials typically shows a two tone appearance with a fish scale pattern on H&E?

A. Cholestyramine
B. Crospovidone
C. Sevelamer
D. Sodium polystyrene sulfonate

Board review answer #1
C. Sevelamer
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