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EDITORIAL SYNOPSIS Salt and water depletion has been noted in 10 patients with long-established ileostomies. Marked renal conservation of sodium and water was present in a number of apparently healthy ileostomy patients. The sodium and potassium concentrations of ileostomy material showed little variation when these patients were in good health but there was a decrease in the sodium concentration and an increase in the potassium concentration during episodes of salt depletion. Greater attention needs to be paid to the fluid and electrolyte requirements of ileostomy patients after they have left hospital.Increased fluid and electrolyte losses are the inevitable result of an ileostomy. They are most marked during the post-operative period and continue even when normal ileostomy function is established.Fowler, Cooke, Brooke, and Cox (1959) state that the body is then well able to conserve essential fluid and electrolytes; this view is supported by two large follow-up studies by Rogers, Bargen, and Black (1954) and by Brooke (1956) who do not mention the occurrence of fluid and electrolyte disturbances. However, these disturbances are not uncommon in our experience as 10 of 60 out-patients with ileostomies who were seen in the period January 1959 to June 1961 developed symptoms of sodium and water depletion. With a view to decreasing the frequency of the latter complication we have studied fluid and electrolyte losses both in apparently healthy and in salt-depleted patients. The clinical features of the 10 patients with salt and water depletion and the results of the study will be described. CLINICAL EXPERIENCETen patients who had had either a subtotal or total colectomy with ileostomy for ulcerative colitis from one month to two years previously developed sodium and water depletion. Five of the group were admitted to hospital. Each patient had been in good health until the onset of the present illness.Acute sodium and water depletion occurred in three patients as a result of an illness suggestive of gastro-enteritis. Each patient complained of diarrhoea and vomiting; other members of one patient's family had a similar illness. One patient fainted after his ileostomy bag rapidly filled; another developed postural hypotension and was anuric for two days before admission. A third patient had marked hypotension when seen by the referring doctor and was found to be dehydrated on arrival. Rapid intravenous fluid and electrolyte replacement was necessary in two patients to restore their usual state of health.Sodium depletion developed less dramatically in seven patients, two of whom became oliguric. Three patients complained of headache, anorexia, nausea, and muscle cramps during a hot spell. Salt and water intake was increased but several days passed before a sense of well-being returned. Another three patients had symptoms of sodium depletion during episodes of transient intestinal obstruction producing colicky abdominal pain and diarrhoea. Anorexia, malaise, and muscle cramps disappeared after crushed salt tablets were...

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SUMMARY The effect of long‐term tetracycline and steroid therapy, colectomy and biliary drainage on the clinical course, the results of liver‐function tests and hepatic histological changes in seven cases of pericholangitis and ulcerative colitis have been assessed. Tetracycline was given to six patients for periods varying from one and a half to six years in a maintenance dose of 500 mg. per day, and prednisone was given to three patients for periods of five, five and ten years respectively. None of the forms of treatment used had an effect on the clinical course, the pathological changes or the results of liver‐function tests in this disease. Attacks of cholestasis and cholangitis occurred with equal frequency and severity both before and after therapy. The hypercholesterolæmia and raised serum alkaline phosphatase level persisted, and the expected progression from acute to subacute to chronic pericholangitis, and in some cases to post‐necrotic cirrhosis, occurred in spite of therapy.

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