DOSAGE AND ADMINISTRATION
Suspension of this drug should be freshly prepared and not stored beyond 24 hours.
The average daily adult dose of the resin is 15 g to 60 g. This is best provided by administering 15 grams (approximately 4 level teaspoons) of Kionex® one to four times daily. One gram of Kionex® contains 4.1 mEq of sodium; one level teaspoon contains approximately 3.5 grams of Kionex® and 15 mEq of sodium. (A heaping teaspoon may contain as much as 10 to 12 grams of Kionex®.) Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33 percent, about one third of the resin's actual sodium content is being delivered to the body.
In smaller children and infants, lower doses should be employed by using as a guide a rate of 1 mEq of potassium per gram of resin as the basis for calculation.
Each dose should be given as a suspension in a small quantity of water or, for greater palatability, in syrup. The amount of fluid usually ranges from 20 to 100mL, depending on the dose, or may be simply determined by allowing 3 to 4 mL per gram resin.
The resin may be introduced into the stomach through a plastic tube and, if desired, mixed with a diet appropriate for a patient in renal failure.
The resin may also be given, although with less effective results, in an enema consisting (for adults) of 30 g to 50 g every six hours. Each dose is administered as a warm emulsion (at body temperature) in 100 mL of aqueous vehicle, such as sorbitol. The emulsion should be agitated gently during administration. The enema should be retained as long as possible and followed by a cleansing enema.
After an initial cleansing enema, a soft, large size (French 28) rubber tube is inserted into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon, and taped in place. The resin is then suspended in the appropriate amount of aqueous vehicle at body temperature and introduced by gravity, while the particles are kept in suspension by stirring. The suspension is flushed with 50 mL or 100 mL of fluid, following which the tube is clamped and left in place. If back leakage occurs, the hips are elevated on pillows or a knee-chest position is taken temporarily. A somewhat thicker suspension may be used, but care should be taken that no paste is formed, because the latter has a greatly reduced exchange surface and will be particularly ineffective if deposited in the rectal ampulla. The suspension is kept in the sigmoid colon for several hours, if possible. Then the colon is irrigated with nonsodium containing solution at body temperature in order to remove the resin. Two quarts of flushing solution may be necessary. The returns are drained constantly through a Y tube connection. Particular attention should be paid to this cleansing enema when sorbitol has been used.
The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia.
Kionex® should not be heated for to do so may alter the exchange properties of the resin.