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Colon Necrosis Due to Sodium Polystyrene Sulfonate with and without Sorbitol: An Experimental Study in Rats.

Ayoub I, Oh MS, Gupta R, McFarlane M, Babinska A, Salifu MO - PLoS ONE (2015)

Bottom Line: They were sacrificed after 48 hours of enema administration or earlier if they were very sick.There was no difference between sorbitol and mannitol when given without SPS.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.

View Article: PubMed Central - PubMed

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.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus

Pathologic findings of rats’ colon with the different enema solutions.Fig 1a: Control rats with distal colon showing preserved crypt architecture and minimal inflammation. Fig 1b: Sorbitol (33%) with transmural necrosis showing trans-mural necrosis. Fig 1c: Mannitol (33%) with transmural ischemia. Fig 1d: SPS with sorbitol (33%) showing transmural infarction with crystal deposition. Fig 1e: SPS with normal saline with trans-mural ischemia and crystal deposition. Fig 1f: SPS with water showing sub-mucosal edema and crystal deposition in the serosa with accompanying acute inflammation. Hematoxylin-Eosin of cross-section of rat colons: images on the left panel (Fig 1a-f) represent original magnifications x40; images on the right panel (Fig 1a-f) represent original magnifications x200. Black arrows indicate magnified area.
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pone.0137636.g001: Pathologic findings of rats’ colon with the different enema solutions.Fig 1a: Control rats with distal colon showing preserved crypt architecture and minimal inflammation. Fig 1b: Sorbitol (33%) with transmural necrosis showing trans-mural necrosis. Fig 1c: Mannitol (33%) with transmural ischemia. Fig 1d: SPS with sorbitol (33%) showing transmural infarction with crystal deposition. Fig 1e: SPS with normal saline with trans-mural ischemia and crystal deposition. Fig 1f: SPS with water showing sub-mucosal edema and crystal deposition in the serosa with accompanying acute inflammation. Hematoxylin-Eosin of cross-section of rat colons: images on the left panel (Fig 1a-f) represent original magnifications x40; images on the right panel (Fig 1a-f) represent original magnifications x200. Black arrows indicate magnified area.

Mentions: No pathologic changes were seen in group I (control rats) (Fig 1A). One rat in each of the group II (rats which received 33% of sorbitol) and group III (rats which received 33% mannitol) showed foci of transmural ischemic changes in the distal colon consistent with surface ulceration, submucosal edema, transmural acute inflammation and necrosis (Fig 1B and 1C). All rats in group I, II and III survived until sacrificed. In group IV, V and VI (rats which received SPS in 33% sorbitol, SPS in normal saline, and SPS in distilled water respectively) the pathologic changes showed SPS crystal deposition mostly in the serosa accompanied by acute inflammation, necrosis and mucosal erosion. The crystal deposition was focal and the accompanying inflammation extended laterally and transmurally to involve the mucosa. Separate areas of mucosal damage were present. These changes were seen mainly in the distal colon. However, two rats in group IV (SPS alone) and one rat in group V (SPS and sorbitol) showed damage in the entire colon. In group IV, 4 rats showed the crystal deposition and 2 had both transmural ischemia and the crystal deposition (Fig 1D). In group V all 3 rats had the crystal deposition and one of the rat colon showed extensive mucosal ulceration (Fig 1E). In group VI (SPS and water), 4 rats showed the crystal deposition and 2 had mucosal ulcerations (Fig 1F)


Colon Necrosis Due to Sodium Polystyrene Sulfonate with and without Sorbitol: An Experimental Study in Rats.

Ayoub I, Oh MS, Gupta R, McFarlane M, Babinska A, Salifu MO - PLoS ONE (2015)

Pathologic findings of rats’ colon with the different enema solutions.Fig 1a: Control rats with distal colon showing preserved crypt architecture and minimal inflammation. Fig 1b: Sorbitol (33%) with transmural necrosis showing trans-mural necrosis. Fig 1c: Mannitol (33%) with transmural ischemia. Fig 1d: SPS with sorbitol (33%) showing transmural infarction with crystal deposition. Fig 1e: SPS with normal saline with trans-mural ischemia and crystal deposition. Fig 1f: SPS with water showing sub-mucosal edema and crystal deposition in the serosa with accompanying acute inflammation. Hematoxylin-Eosin of cross-section of rat colons: images on the left panel (Fig 1a-f) represent original magnifications x40; images on the right panel (Fig 1a-f) represent original magnifications x200. Black arrows indicate magnified area.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587365&req=5

pone.0137636.g001: Pathologic findings of rats’ colon with the different enema solutions.Fig 1a: Control rats with distal colon showing preserved crypt architecture and minimal inflammation. Fig 1b: Sorbitol (33%) with transmural necrosis showing trans-mural necrosis. Fig 1c: Mannitol (33%) with transmural ischemia. Fig 1d: SPS with sorbitol (33%) showing transmural infarction with crystal deposition. Fig 1e: SPS with normal saline with trans-mural ischemia and crystal deposition. Fig 1f: SPS with water showing sub-mucosal edema and crystal deposition in the serosa with accompanying acute inflammation. Hematoxylin-Eosin of cross-section of rat colons: images on the left panel (Fig 1a-f) represent original magnifications x40; images on the right panel (Fig 1a-f) represent original magnifications x200. Black arrows indicate magnified area.
Mentions: No pathologic changes were seen in group I (control rats) (Fig 1A). One rat in each of the group II (rats which received 33% of sorbitol) and group III (rats which received 33% mannitol) showed foci of transmural ischemic changes in the distal colon consistent with surface ulceration, submucosal edema, transmural acute inflammation and necrosis (Fig 1B and 1C). All rats in group I, II and III survived until sacrificed. In group IV, V and VI (rats which received SPS in 33% sorbitol, SPS in normal saline, and SPS in distilled water respectively) the pathologic changes showed SPS crystal deposition mostly in the serosa accompanied by acute inflammation, necrosis and mucosal erosion. The crystal deposition was focal and the accompanying inflammation extended laterally and transmurally to involve the mucosa. Separate areas of mucosal damage were present. These changes were seen mainly in the distal colon. However, two rats in group IV (SPS alone) and one rat in group V (SPS and sorbitol) showed damage in the entire colon. In group IV, 4 rats showed the crystal deposition and 2 had both transmural ischemia and the crystal deposition (Fig 1D). In group V all 3 rats had the crystal deposition and one of the rat colon showed extensive mucosal ulceration (Fig 1E). In group VI (SPS and water), 4 rats showed the crystal deposition and 2 had mucosal ulcerations (Fig 1F)

Bottom Line: They were sacrificed after 48 hours of enema administration or earlier if they were very sick.There was no difference between sorbitol and mannitol when given without SPS.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.

View Article: PubMed Central - PubMed

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.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus