Infectious colitis exacerbation following a single dose of Kayexalate

Kayexalate, an important treatment for hyperkalemia, especially in chronic renal failure, can be administered orally or as an enema. Potential side effects include constipation, vomiting, diarrhea, and nausea, with the most significant being colitis due to ulceration and wall perforation. This effect is most commonly observed in patients with chronic kidney disease. We report a case of a 76-year-old man known to have heart failure, hemiplegia and no history of chronic renal failure (CRF) who presented with septic shock and fever. A CT scan and colonoscopy revealed infectious colitis. He was admitted to the intensive care unit for monitoring and further management. One day later, laboratory results showed hyperkalemia that was likely due to acute renal failure (ARF) secondary to septic shock, and a single dose of 30 g of Kayexalate was administered to prevent life-threatening arrhythmias. However, two days later, the patient experienced worsening abdominal pain. A follow-up colonoscopy revealed worsening colitis, indicating an exacerbation of his condition due to Kayexalate. Medical management with antibiotics and adequate hydration was continued, leading to an improvement in his abdominal pain, then the patient was discharged. This case report highlights a rare occurrence of Kayexalate-worsening colitis after just a single dose in a patient with no history of kidney disease. It aims to raise awareness about avoiding even one dose of Kayexalate in patients with pre-existing colitis.