A person treated with oral kayexalate (sodium polystyrene sulfonate) may aspirate the drug, followed by a pneumonitis.
Clinical features:
(1) The patient is being treated with oral kayexalate.
(2) There is a variable history of aspiration.
(3) The patient develops respiratory symptoms ranging from shortness of breath to respiratory failure.
(4) A chest X-ray shows a pulmonary infiltrate.
(5) Microscopic examination of a lung biopsy or bronchoalveolar lavage sample shows a basophilic, amorphous material within the alveolar space or contents.
The crystalline material can be identified under the microscope using infrared microspectrophotometric analysis.
Much of the pulmonary injury may be related to aspiration of gastric contents, with kayexalate as a bystander. Its presence does confirm aspiration.
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