title: Colon Necrosis Due to Sodium Polystyrene Sulfonate with and without Sorbitol: An Experimental Study in Rats.
abstract: BACKGROUND
  Based on a single rat study by Lillemoe et al, the consensus has been formed to implicate sorbitol rather than sodium polystyrene sulfonate (SPS) as the culprit for colon necrosis in humans treated with SPS and sorbitol. We tested the hypothesis that colon necrosis by sorbitol in the experiment was due to the high osmolality and volume of sorbitol rather than its chemical nature.
  
  
  METHODS
  26 rats underwent 5/6 nephrectomy. They were divided into 6 groups and given enema solutions under anesthesia (normal saline, 33% sorbitol, 33% mannitol, SPS in 33% sorbitol, SPS in normal saline, and SPS in distilled water). They were sacrificed after 48 hours of enema administration or earlier if they were very sick. The gross appearance of the colon was visually inspected, and then sliced colon tissues were examined under light microscopy.
  
  
  RESULTS
  1 rat from the sorbitol and 1 from the mannitol group had foci of ischemic colonic changes. The rats receiving SPS enema, in sorbitol, normal saline, distilled water, had crystal deposition with colonic necrosis and mucosal erosion. All the rats not given SPS survived until sacrificed at 48 h whereas 11 of 13 rats that received SPS in sorbitol, normal saline or distilled water died or were clearly dying and sacrificed sooner. There was no difference between sorbitol and mannitol when given without SPS.
  
  
  CONCLUSIONS
  In a surgical uremic rat model, SPS enema given alone or with sorbitol or mannitol seemed to cause colon necrosis and high mortality rate, whereas 33% sorbitol without SPS did not.
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America; Department of Medicine, Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ayoub
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America.
authors.forename: Man S
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Pathology, SUNY Downstate Medical center, Brooklyn, New York, United States of America.
authors.forename: Raavi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: McFarlane
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Babinska
authors.affiliation: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America.
authors.forename: Moro O
authors.initials: MO
authors.lastname: Salifu
mesh_terms: D000818:Animals; D003106:Colon / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D008297:Male; D009336:Necrosis / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D011137:Polystyrenes / Q000009:adverse effects* / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D013012:Sorbitol / Q000009:adverse effects* / Q000494:pharmacology
chemical_list: D011137:Polystyrenes; D013012:Sorbitol; C003321:polystyrene sulfonic acid