Safe management of ileostomates with high-output stomas

Abstract

An ileostomy is where the small bowel is diverted to the abdominal surface resulting in the formation of a stoma. An Ileostomy can be temporary or permanent and produces loose faeces. Some ileostomates can develop high output in the early postoperative stage. Most will resolve, some will require ongoing treatment and management. While patients are monitored closely according to protocol in hospital once discharged into the community, there appears to be little standardisation. A literature search revealed that existing guidelines are for management of patients in the acute care setting. However, if not adequately prepared and monitored, patients with prolonged high output are at risk of complications including dehydration, acute kidney injury and malnutrition. This article discusses the development of a guideline aimed at improving education, monitoring and ultimately improving outcomes for patients with high-output stomas in the community.

Dietary management in people with an ileostomy: a scoping review protocol

“…7 People with an ileostomy, and even more so with jejunostomy, are at greater risk of nutritional deficiencies than people with a colostomy due to removal of the colon and varying amounts of the ileum. 8,9 The colon reabsorbs fluids and electrolytes, therefore, people with an ileostomy or jejunostomy have greater losses of these in their faeces and looser output. 10,11 Definition of high-output stoma varies and is usually considered as output greater than between 1 and 2L/day.…”

“…10,11 Definition of high-output stoma varies and is usually considered as output greater than between 1 and 2L/day. 8,10,11 Mismanagement of high-output stomas can lead to dehydration, acute kidney injury and malnutrition. 10,12 The shorter the length of GI tract left available for digestion, the greater the risk of malabsorption of nutrients, and therefore malnutrition.…”

“…15,16 Constipation and odour are more common complications of a colostomy. 16,17 Aspects of dietary management include: fibre restriction to prevent blockage and high output; 6,8,12 oral rehydration solutions and/or fluid restriction for high output; 8,12 added salt for people with high output ileostomy; 12 white, starchy carbohydrates and gelatine containing sweets to thicken output; 18 increased fibre and fluid for constipation; 6,19 avoidance of onions, beans and carbonated drinks to reduce wind. 6 Acceptability of, and adherence to, dietary interventions for stoma management is important in improving clinical and patient reported outcomes.…”

Risk factors for developing high-output ileostomy: a retrospective study

“…Generally, half of the EHOS patients required no special drug intervention until recuperation, while the other half required drug intervention [7]. For the treatment and management of HOS, patients should be managed and guided throughout the hospital and after discharge [16]. In addition to basic treatments (such as restricting fluid intake, rehydration and correcting electrolyte disturbance) reducing the secretion of somatostatin and oral intake of loperamide is also effective in reducing discharge.…”

Ostomías de alto gasto en pacientes adultos

“…De hecho, la ostomía de alto gasto se ha identificado como precursor de deshidratación y disfunción renal, con una incidencia de aproximadamente 1-17% y un porcentaje de readmisión hospitalaria de 4-43% (4). A su vez, se ha registrado que en las personas portadoras de ileostomías, aproximadamente el 16% desarrollará de forma temprana un alto gasto y el 7% de estos individuos podría presentar esta condición de forma prolongada, requiriendo un manejo continuo (6). Por todo lo anteriormente explicado, se considera un tema de suma importancia para ser estudiado e investigado.…”