Acute abdomen with colonic necrosis induced by kayexalate-sorbitol

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increa se awareness of this complication, we report a case of necrosis of the tran sverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalem ia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration. Prompt surgical resection of the necrotic transvers e colon permitted rapid recovery of bowel function. Although SPS crystals a re seen microscopically in the necrotic bowel, experimental evidence implic ates the sorbitol component of the SPS-sorbitol in the pathogenesis of colo nic necrosis. A high index of suspicion for the unusual complication of col onic necrosis after oral or rectal administration of SPS-sorbitol may allow prompt recognition and surgical cure.