High Output Stoma Management

Definition and Risk Factors

• High output ileostomy is defined as 1000-2000 mL/24 hours, and output greater than 2000 mL/24 hours increases the risk of dehydration, electrolyte imbalance, and malnutrition significantly 1, 2
• The European Crohn’s and Colitis Organisation recommends that high output ileostomy be managed with close monitoring of fluid and electrolyte balance 1, 2

Monitoring Parameters

• The European Society of Clinical Nutrition and Metabolism recommends monitoring urine volume, with a target of at least 800 mL per day 5, 3, 6, 4
• The American Gastroenterological Association recommends monitoring urine sodium levels, with a target of greater than 20 mmol/L to indicate adequate sodium intake 5, 1, 2, 3, 4
• Regular monitoring of body weight is recommended to assess hydration status 5, 3, 6

Management Strategies

• For patients with marginal high stoma output (1-1.5 liters), oral fluid restriction (<1 liter/day) and addition of salt to the diet may be sufficient 5, 3, 6
• The British Dietetic Association recommends avoiding hypotonic fluids (water, tea, coffee, fruit juices) as they can increase stoma sodium losses 5, 3, 6, 4
• Hypertonic fluids (fruit juices, cola) can also cause water and sodium loss 5