A comparison between fructose 1,6-diphosphate, glucose, or normal saline infusions and species-specific blood exchange transfusions in the treatment of bowel ischemia

Infusion of fructose 1,6-diphosphate, (FDP), the rate-limiting substrate in anaerobic metabolism, decreases infarction in the ischemic heart. This study evaluates the effect of FDP (5% in H2O), glucose (D5W), or normal saline (N/S) infusions and species-specific blood (SSB) exchange transfusions on mortality rates and bowel infarction in rats with intestinal ischemia. One hundred twenty Sprague-Dawley male rats (50 to 75 gm) were divided into six experimental groups. Group I controls (n = 20) underwent sham laparotomy. Group II (n = 20) underwent superior mesenteric artery (SMA) occlusion for 90 minutes. Group III rats (n = 20) were infused with FDP with SMA occlusion (90 minutes). Group IV rats (n = 20) were infused with D5W with SMA occlusion (90 minutes). Group V rats (n = 20) were infused with N/S with SMA occlusion (90 minutes). Group VI rats (n = 20) received species-specific exchange transfusion after SMA occlusion (90 minutes). A typical rat given 1 ml of D5W/75 gm had a serum glucose of 478 ng/dl with an osmolality of 293 mosm/L. After being given 1 ml of NS/75 gm, rats had a serum glucose level of 170 mg/dl with an osmolality of 291 mos/ml. Control rats had a serum glucose level of 139 mg/dl with an osmolality of 295 mosm/L. Survival at 48 hours without bowel infarction was 20 of 20 (100%) in group I, three of 20 (15%) in group II, 12 of 20 (60%) in group III, 12 of 20 (60%) in group IV, five of 20 (25%) in group V, and six of 20 (30%) in group VI (p less than 0.05 groups III and IV versus group II). FDP and D5W infusions increased survival after bowel ischemia in the rat. The mechanism of action may involve provision of a substrate for anaerobic metabolism to ischemic bowel via collateral pathways, hemodilution, and/or volume expansion.