How does kayexalate work? Is it useful in the ED?
Kayex alone adsorbs cations, and in theory, in settings of hyperK, potassium would be the adsorbed cation. The added sorbitol induces stooling, which in 24-48hours may help to decrease serum K+.
This does not help in the acute setting and kayex is not w/o significant risks. In the unstable patient/w/ecg changes, calcium is appropriate. In the “acidotic” patient, sodium bicarb is appropriate. Insulin (+d50) and albuterol can help acutely. But treating the underlying problem is the key.
http://emcrit.org/misc/is-kayexalate-useless/ Review the listed references (and share with your IM colleagues, etc) and review the podcast.