Safety of Sodium Zirconium Cyclosilicate in Critically Ill Patients With Impaired Gastric Motility: A Case of Persistent Intragastric Precipitation

Sodium zirconium cyclosilicate (SZC) is a novel potassium-binding agent used to treat hyperkalemia. Although SZC is generally considered safe, its efficacy and safety in critically ill patients remain unclear. We report a novel adverse event of persistent intragastric SZC precipitation in a critically ill patient. A man in his 20s was admitted after a cardiac arrest and developed hyperkalemia and renal dysfunction. Following four days of SZC administration via a nasogastric tube, chest radiography revealed a high-density intragastric mass. Gastric lavage and Gastrografin administration confirmed the presence of the precipitate and revealed severely impaired gastric motility. This case highlights the potential risks of SZC use in critically ill patients with impaired gastric motility. Factors contributing to precipitation include decreased bowel peristalsis due to intestinal ischemia and the use of sedatives and vasopressors. Close radiographic monitoring of SZC transit is recommended for early detection. Further research is required to establish optimal management strategies for such adverse events.