Sorbitol Induced Colonic Necrosis

Abstract

Purpose: Sodium polystyrene sulfonate is a cation exchange resin, which primarily acts in the colon. It is often administered with an osmotic laxative (sorbitol), PO or rectally. Gastrointestinal adverse reactions include anorexia, nausea, vomiting, constipation, fecal impaction, and intestinal necrosis (rare). Here we present an uncommon case of ulceration of the ascending colon following multiple oral administrations of sodium polystyrene sulfonate-sorbitol. Methods: A 70 yo♀ was admitted with urinary tract infection and pre-renal azotemia. She received 5 oral doses of Sodium polystyrene sulfonate-sorbitol for hyperkalemia and later developed lower abdominal pain. Colonoscopy revealed a solitary 5 cm raised erythematous ulcer in the ascending colon (Fig. 1). Biopsy showed necrotic tissue and purple crystals in inflammatory exudates (Fig. 2). Patient's symptoms were improved spontaneously after discontinuation of therapy.Figure 2: Sodium polystyrene sulfonate (Purple) crystals within the Inflamatory exudates.Figure 1: Colonoscopic view of the ascending colon ulcer.Results: Colonoscopic and pathologic findings were consistent with Sorbitol induced colitis. First case of uremia and colonic necrosis after sodium polystyrene sulfonate-sorbitol enema was reported in 1987. A study in a rat model has shown that sorbitol is in fact the cause of the intestinal necrosis. The exact mechanism by which sorbitol induces intestinal necrosis is unknown. Conclusion: Sorbitol induced colitis is a rare condition which may have significant morbidity and mortality. Considering the adverse reactions, this therapy must be used with caution and should be limited to life-threatening hyperkalemia. Physicians must remain vigilant for any signs or symptoms of intestinal problems.