Objective: There are only few cases of intestinal necrosis secondary to administration of kayexalate described in the literature, most of them from postoperative patients, having the largest study only 11 patients in 9 years. We report our experience in the last 4 years with a brief review of the pathophysiology and histologic aspects of the lesions induced by the kayexalate. Method: Between 2008 and March 2012 seven patients were diagnosed with ischemic necrosis related to kayexalate administration, five in colon biopsy and two in resection specimens. They're comorbidities and clinical evolution was extracted from the medical records. Results: The patients' age ranged between 47 and 78 years. In one case we had the clinical information of chronic renal insufficiency. In three of them, there was no previous history of renal impairment. One patient developed symptoms after one single administration of kayexalate. The clinical presentation ranged from abdominal pain, gastrointestinal bleeding and three of them had a fatal outcome.