A Single Urine Sodium Measurement May Validly Estimate 24‐hour Urine Sodium Excretion in Patients With an Ileostomy

Abstract

Background Sodium deficiency in patients with an ileostomy is associated with chronic dehydration and may be difficult to detect. We aimed to investigate if the sodium concentration in a single spot urine sample may be used as a proxy for 24‐hour urine sodium excretion. Methods In a prospective observational study with 8 patients with an ileostomy and 8 volunteers with intact intestines, we investigated the correlations and agreements between spot urine sodium concentrations and 24‐hour urine sodium excretions. Spot urine samples were drawn from every micturition during 24 hours, and relevant blood samples were drawn. All participants documented their food and fluid intakes. Results There was a high and statistically significant correlation between 24‐hour natriuresis and urine sodium concentrations in both morning spot samples (n = 8, Spearman's rho [ρ] = 0.78, P = 0.03) and midday spot samples (n = 8, ρ = 0.82, P = 0.02) in the patients with an ileostomy. The agreement between methods was fair (bias = −1.5, limits of agreement = −32.3 to 29.4). There were no statistically significant associations for evening samples or for samples from volunteers with intact intestines independently of time of day. Conclusion A single spot urine sodium sample obtained in the morning or midday may estimate 24‐hour urine sodium excretion in patients with an ileostomy and thus help to identify sodium depletion.

Nutritional Issues Faced by Patients with Intestinal Stoma: A Narrative Review

“…They found that such consultations significantly reduced the rate of hospital readmissions associated with high-secreting stoma and dehydration, which also resulted in significant savings for the hospital [ 13 ]. Other researchers have reached similar conclusions, citing HOS as the most common cause of readmission [ 37 , 38 , 39 ]. Many researchers reported significantly lower rates of patients returning to the hospital after implementation of a follow-up nutritional consultation compared to the non-intervention group in a retrospective study compared to other researchers [ 13 , 43 , 44 , 45 ].…”

“…On the other hand, patients with an ileostomy who do not have this problem, and patients with a colostomy should follow the principles of a healthy diet, e.g., not overdoing the supply of salt, monitoring for signs of dehydration and checking sodium levels prophylactically [ 23 , 38 ]. Pedersen et al [ 39 ] report that in patients with an ileostomy, a single spot urine sodium sample taken in the morning to noon hours can reliably estimate the 24-h urine sodium excretion. Testing this in people with an ileostomy can, therefore, quickly identify a sodium deficiency and the sodium supply can be increased, if needed [ 39 ].…”

“…Pedersen et al [ 39 ] report that in patients with an ileostomy, a single spot urine sodium sample taken in the morning to noon hours can reliably estimate the 24-h urine sodium excretion. Testing this in people with an ileostomy can, therefore, quickly identify a sodium deficiency and the sodium supply can be increased, if needed [ 39 ]. According to Medlin et al [ 23 ] and Mountford et al [ 31 ], patients with HOS and dehydration who frequently experience electrolyte disturbances should avoid excessive intake of hypotonic drinks (e.g., water, tea, and coffee limited to 500 to 1500 mL/day).…”

Diet management in congenital diarrheas and enteropathies – general concepts and disease-specific approach, a narrative review

“…Urine sodium will be low when body fluid status is uncorrected. Fractional sodium excretion is a more accurate marker of sodium status because it is independent of urine flow [ [93] , [94] , [95] ]. Progressive weight loss and dehydration are common at disease onset, and acute renal failure may develop in patients with delayed diagnosis [ 96 ].…”