BMJ Case Reports 2017; doi:10.1136/bcr-2017-221790
  • Unexpected outcome (positive or negative) including adverse drug reactions

Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis

  1. Abdurhman Ahmed1
  1. 1Department of Internal Medicine, SBH Health System, Bronx, New York, USA
  2. 2Department of Radiology, SBH Health System, Bronx, New York, USA
  1. Correspondence to Dr Roberto Christian Cerrud-Rodriguez, robertocerrud{at}
  • Accepted 27 October 2017
  • Published 9 November 2017


We present the case report of an 80-year-old woman with chronic kidney disease stage G5 admitted to the hospital with fluid overload and hyperkalaemia. Sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol suspension was given orally to treat her hyperkalaemia, which precipitated an episode of SPS in sorbitol-induced ischaemic colitis with the subsequent complication of vancomycin-resistant Enterococcus (VRE) bacteraemia. SPS (Kayexalate) in sorbitol suspension has been implicated in the development of intestinal necrosis. Sorbitol, which is added as a cathartic agent to decrease the chance of faecal impaction, may be primarily responsible through several proposed mechanisms. The gold standard of diagnosis is the presence of SPS crystals in the colon biopsy. On a MEDLINE search, no previous reports of a VRE bacteraemia as a complication of biopsy-confirmed SPS in sorbitol ischaemic colitis were found. To the best of our knowledge, ours would be the first such case ever reported.


  • Contributors RCC-R was in charge of performing the chart review, obtaining consent from the patient and doing the initial literature review on the topic. He was also responsible for writing the drafts for the case report and making any modifications required by the Institutional Review Board or the supervising attending physician. DA-A was in charge of additional literature review, on obtaining additional sources for medical records of the patient that could be relevant to our case report and of obtaining authorisation from the Radiology and Pathology Department to use the images presented in this case report. BBC provided additional interpretation of the images obtained during the patient’s hospital admission during the write-up of this case report. Additionally, he was directly involved in the patient’s clinical care as the radiologist in charge of notifying the multiple life-threatening findings to the primary team in an expedited fashion. AA was in charge of the overall execution of the case report, verifying that all steps required by our Institutional Review Board were fulfilled, as well as proofreading of the initial versions of the manuscript and approving the final version of the submitted manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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