関: calcium polystyrene sulfonate、Kayexalate、sodium polystyrene sulfonate

WordNet

a polymer of styrene; a rigid transparent thermoplastic; "expanded polystyrene looks like a rigid white foam and is used as packing or insulation"
a salt of sulphonic acid

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ポリスチレン,スチロール樹脂(温遅調節装置の絶縁材などに用いる)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/31 04:22:06」(JST)

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Polystyrene sulfonates are polystyrene sulfonic acid polysalts. In medical applications the counter ions are usually sodium and calcium. Polystyrene sulfonates are indicated as potassium binders in acute and chronic kidney disease for patients suffering from hyperkalaemia (abnormal high blood serum potassium levels), which may e.g. result in weakness or irregular heartbeat.^[1]^[2]

Sodium polystyrene sulfonate (INN) is marketed under trade names such as Kayexalate, Kionex, and Resonium A. This salt has technical applications as well.

Calcium polystyrene sulfonate (INN) is marketed as Calcium Resonium, Sorbisterit, and Resikali.

Uses

Micrograph showing sodium polystyrene sulfonate crystals (purple – at top of the image) in the biopsy of a colonic mass. H&E stain.

Polystyrene sulfonates are used to remove dangerously high levels of potassium in the blood (e.g., due to digoxin toxicity), since hyperkalemia can cause cardiac arrhythmia and death. They are effective at reducing serum potassium levels,^[3] although there is concern about possible side effects when it is mixed with sorbitol.^[4]

Technical uses

Sodium polystyrene sulfonate is used as a superplastifier in cement, as a dye improving agent for cotton and as proton exchange membranes in fuel cell applications. Crosslinked polystyrenes that are then sulfonated have found widespread use as ion-exchange resins.

Mechanism of action

Polystyrene sulfonates are dissolved in water and administered orally (with a meal) or rectally, by retention enema.^[5] In the large intestines, potassium derived from food is exchanged for sodium or calcium ions, respectively.^[6] Finally, the indigestible potassium polystryene sulfonate complex is excreted with the feces, preventing the absorption of potassium into the blood stream. Hence, the serum potassium level decreases.

Side effects

Intestinal disturbances are common, including loss of appetite, nausea, vomiting, and constipation. In rare cases it has been associated with colonic necrosis.^[7] Changes in electrolyte blood levels may occur such as hypermagnesemia, hypercalcemia and hypokalemia.^[1]

Chemistry

Polystyrene sulfonic acid is a polymer and ionomer based on polystyrene. The polyanion is a white or off-white powder, readily soluble in water, and insoluble in lower alcohols.

It may be prepared by polymerization or copolymerization of styrene sulfonate^{[citation needed]} or by sulfonation of polystyrene. The harsh conditions used in this procedure lead to the occurrence of a number of side reactions. Double substitutions of the phenyl rings are known to occur, even with conversions well below 100%. Crosslinking reactions are also found, where condensation of two sulfonic acid groups yield a sulfonyl crosslink. On the other hand, the use of milder conditions such as acetyl sulfate leads to incomplete sulfonation. Recently, the atom transfer radical polymerization (ATRP) of protected styrenesulfonates has been reported,^[8]^[9] leading to well defined linear polymers, as well as more complicated molecular architectures.^[10]

References

^ ^a ^b Sorbisterit – Summary of Product Characteristics; Retrieved: 27 November 2009.
^ U.S. National Library of Medicine, National Institutes of Health, URL: http://www.nlm.nih.gov/medlineplus/ency/article/001179.htm; Retrieved: 27 November 2009
^ Watson, M; Abbott, KC; Yuan, CM (2010). "Damned if you do, damned if you don't: potassium binding resins in hyperkalemia.". Clinical journal of the American Society of Nephrology : CJASN 5 (10): 1723–6. doi:10.2215/CJN.03700410. PMID 20798253.
^ Sterns RH, Rojas M, Bernstein P, Chennupati S (May 2010). "Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective?". J. Am. Soc. Nephrol. 21 (5): 733–5. doi:10.1681/ASN.2010010079. PMID 20167700.
^ Medicines Complete: Martindale: The Complete Drug Reference, URL: http://www.medicinescomplete.com/mc/martindale/2009/5004-l.htm; Retrieved: 27 November 2009
^ Lederer, E., Ouseph, R., Nayak, V., Dinh, S., URL: http://emedicine.medscape.com/article/240903-treatment; Retrieved: 27 November 2009
^ Rogers FB, Li SC (August 2001). "Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: case report and review of the literature". J Trauma 51 (2): 395–7. doi:10.1097/00005373-200108000-00031. PMID 11493807. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0022-5282&volume=51&issue=2&spage=395.
^ Sikkema, FD; Comellas-Aragonès, M; Fokkink, RG; Verduin, BJ; Cornelissen, JJ; Nolte, RJ (2007). "Monodisperse polymer-virus hybrid nanoparticles". Organic & biomolecular chemistry 5 (1): 54–7. doi:10.1039/b613890j. PMID 17164905.
^ Lienkamp, Karen; Schnell, Ingo; Groehn, Franziska; Wegner, Gerhard (2006). "Polymerization of Styrene Sulfonate Ethyl Ester by ATRP: Synthesis and Characterization of Macromonomers for Suzuki Polycondensation". Macromolecular Chemistry and Physics 207 (22): 2066. doi:10.1002/macp.200600322.
^ Lienkamp, Karen; Ruthard, Christian; Lieser, GüNter; Berger, RüDiger; Groehn, Franziska; Wegner, Gerhard (2006). "Polymerization of Styrene Sulfonate Ethyl Ester and Styrene Sulfonate Dodecyl Ester by ATRP: Synthesis and Characterization of Polymer Brushes". Macromolecular Chemistry and Physics 207 (22): 2050. doi:10.1002/macp.200600321.

External links

Potassium and your CKD Diet - kidney.org
Information on Hyperkalaemia by Fresenius Medical Care - fmc-renalpharma.com

UpToDate Contents

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1. 小児における高カリウム血症の管理 management of hyperkalemia in children
2. 成人における高カリウム血症の治療および予防 treatment and prevention of hyperkalemia in adults
3. 腫瘍崩壊症候群：予防および治療 tumor lysis syndrome prevention and treatment
4. 小児における急性腎障害（急性腎不全）の予防およびマネージメント prevention and management of acute kidney injury acute renal failure in children
5. 透析患者における消化管疾患 gastrointestinal disease in dialysis patients

English Journal

Effects of water soaking and/or sodium polystyrene sulfonate addition on potassium content of foods.

Picq C1, Asplanato M, Bernillon N, Fabre C, Roubeix M, Ricort JM.Author information 1Université Montpellier 2 , Montpellier , France .AbstractAbstract In this study, we determined, by atomic absorption spectrophotometry, the potassium amount leached by soaking or boiling foods identified by children suffering from chronic renal failure as "pleasure food" and that they cannot eat because of their low-potassium diet, and evaluated whether addition of sodium polystyrene sulfonate resin (i.e. Kayexalate®) during soaking or boiling modulated potassium loss. A significant amount of potassium content was removed by soaking (16% for chocolate and potato, 26% for apple, 37% for tomato and 41% for banana) or boiling in a large amount of water (73% for potato). Although Kayexalate® efficiently dose-dependently removed potassium from drinks (by 48% to 73%), resin addition during soaking or boiling did not eliminate more potassium from solid foods. Our results therefore provide useful information for dietitians who elaborate menus for people on potassium-restricted diets and would give an interesting alternative to the systematic elimination of all potassium-rich foods from their diet.
International journal of food sciences and nutrition.Int J Food Sci Nutr.2014 Apr 10. [Epub ahead of print]
Abstract In this study, we determined, by atomic absorption spectrophotometry, the potassium amount leached by soaking or boiling foods identified by children suffering from chronic renal failure as "pleasure food" and that they cannot eat because of their low-potassium diet, and evaluated whether a
PMID 24720622

pH-Sensitive Fluorescent Hepatocyte-Targeting Multilayer Polyelectrolyte Hollow Microspheres as a Smart Drug Delivery System.

Zhao X1, Liu P.Author information 1State Key Laboratory of Applied Organic Chemistry and Institute of Polymer Science and Engineering, College of Chemistry and Chemical Engineering, Lanzhou University , Lanzhou 730000, China.AbstractNovel multilayer polyelectrolyte hollow microspheres with pH-sensitive fluorescence and hepatocyte-targeting functions were successfully fabricated via a layer-by-layer (LbL) assembly of fluorescein isothiocyanate (FITC)-modified chitosan (CSFITC) and sodium hyaluronate (HA) (as the polycation and polyanion, respectively) on polystyrene sulfonate (PSS) templates with galactosylated chitosan (GC) as the outermost layer; after etching the templates by dialysis, the aim was to use the microspheres to target hepatocytes specifically. TEM analysis revealed that they have a hollow structure with a particle size of about 260 nm, and DLS analysis demonstrated that they have pH and ionic strength dual-responsive characteristics. The hollow microspheres showed pH-sensitive fluorescence at a very low concentration by fluorescent emission spectra. MTT assays revealed that doxorubicin (a water-insoluble anticancer drug)-loaded (CSFITC/HA)4/GC hollow microspheres can specifically target hepatocytes and exhibit favorable cytocompatibility. Three typical model drugs were loaded into the (CSFITC/HA)4/GC hollow microspheres, and their drug-release kinetics in simulated body fluid (SBF) were estimated with different mathematical models. The results demonstrated that the drug-loading mechanism is chemosorption and the primary governing force for drug release is diffusion. Thus, the designed hollow microspheres are expected to be used for the diagnosis and therapy of hepatic cancer.
Molecular pharmaceutics.Mol Pharm.2014 Apr 7. [Epub ahead of print]
Novel multilayer polyelectrolyte hollow microspheres with pH-sensitive fluorescence and hepatocyte-targeting functions were successfully fabricated via a layer-by-layer (LbL) assembly of fluorescein isothiocyanate (FITC)-modified chitosan (CSFITC) and sodium hyaluronate (HA) (as the polycation and p
PMID 24665978

Cost-utility analysis of sodium polystyrene sulfonate vs. potential alternatives for chronic hyperkalemia.

Little DJ1, Nee R, Abbott KC, Watson MA, Yuan CM.Author information 1Nephrology SVC, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.AbstractPurpose: Hyperkalemia during renin-angiotensin-aldosterone system inhibition (RAAS-I) may prevent optimum dosing. Treatment options include sodium polystyrene sulfonate potassium binding resins, but safety and efficacy concerns exist, including associated colonic necrosis (CN). Alternative agents have been studied, but cost-utility has not been estimated. Methods: We performed a cost-utility analysis of outpatients ≥ 18 years of age receiving chronic RAAS-I, with a history of hyperkalemia or chronic kidney disease, prescribed either sodium polystyrene sulfonate or a theoretical "drug X" binding resin for chronic hyperkalemia. Data were obtained from existing literature. We used a decision analytic model with Monte Carlo probabilistic sensitivity analyses, from a health care payer perspective and a 12-month time horizon. Costs were measured in US dollars. Effectiveness was measured in quality-adjusted life-years (QALYs), and incremental costeffectiveness ratios (ICERs). Results: Drug X could cost no more than $ 10.77 per daily dose to be cost-effective, at a willingnessto- pay (WTP) threshold of $ 50,000/QALY. At $ 40.00 per daily dose, drug X achieved an incremental cost effectiveness ratio of $26,088,369.00 per QALY gained. One-way sensitivity analysis showed sodium polystyrene sulfonate to be the cost-effective option for CN incidences ≤ 19.9%. Limitations include incomplete information on outpatient outcomes and lack of data directly comparing sodium polystyrene sulfonate to potential alternatives. Conclusions: Alternatives may not be cost-effective unless priced similarly to sodium polystyrene sulfonate. This analysis may guide decisions regarding adoption of alternative agents for chronic hyperkalemia control, and suggests that sodium polystyrene sulfonate be employed as an active control in clinical trials of these agents.
Clinical nephrology.Clin Nephrol.2014 Apr;81(4):259-68.
Purpose: Hyperkalemia during renin-angiotensin-aldosterone system inhibition (RAAS-I) may prevent optimum dosing. Treatment options include sodium polystyrene sulfonate potassium binding resins, but safety and efficacy concerns exist, including associated colonic necrosis (CN). Alternative agents ha
PMID 24656316

Japanese Journal

今月の症例ポリスチレンスルホン酸カルシウム内服により回腸狭窄・イレウスを来した1例

加藤総介,小野雄司,高木智史 [他]
日本内科学会雑誌 102(1), 150-152, 2013-01-10
NAID 40019568417

症例報告ポリスチレンスルホン酸ナトリウムおよび球形吸着炭常用による高度便秘から低カリウム性ミオパチーをきたした1例

藤野靖久,井上義博,小野寺誠 [他]
The Japanese journal of clinical toxicology 26(1), 49-53, 2013
NAID 40019614166

陽イオン交換樹脂を用いる放射性セシウムの除去

森田裕子,水村亮介,橘義貴 [他],金澤秀子
分析化学 62(6), 541-545, 2013
… Cation exchange resins (calcium polystyrene sulfonate, Ca-resin and sodium polystyrene sulfonate, Na-resin) have been used as agents to improve hyperkerlemia. …
NAID 130003362066

Related Pictures

★リンクテーブル★

リンク元	「ポリスチレンスルホン酸」
拡張検索	「calcium polystyrene sulfonate」「sodium polystyrene sulfonate」
関連記事	「sulfonate」「polystyrene」

「ポリスチレンスルホン酸」

Polystyrene sulfonate
Systematic (IUPAC) name
	Poly(4-vinylbenzenesulfonic acid)
Clinical data
Trade names	Sodium salt: Kayexalate, Kionex, Resonium A; Calcium salt: Calcium Resonium, Sorbisterit, Resikali
AHFS/Drugs.com	monograph
MedlinePlus	a682108
Pregnancy cat.	C (US)
Legal status	℞ Prescription only
Routes	Oral, retention enema
Pharmacokinetic data
Bioavailability	None
Metabolism	None
Excretion	Faeces (100%)
Identifiers
CAS number	28210-41-5
ATC code	V03AE01
PubChem	CID 75905
DrugBank	DB01344
Chemical data
Formula	[C8H8SO3]n
Mol. mass	1017 – 1019 Daltons
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