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Fluids and Electrolytes with an Ostomy

Fluids and Electrolytes with an Ostomy

Electrolytes are ionic mineral solutions that transmit electricity. Electrolyte balance refers to the combined levels of the different electrolytes found in the blood. The balance of these ions in our body is key to regulate fluid amounts, blood acidity, muscle and nerve health, and all functions from oxygen distribution to fluid delivery to cells. Essentially, electrolytes are the chemicals needed to keep our bodies working.

“Electrolytes refer to the normal chemicals dissolved in body fluids needed to maintain body activity. If electrolytes are out of balance, a person may become weak or ill and may need to take medications by mouth or intravenously. Electrolyte balance (especially potassium and sodium) is important. When the colon (large intestine) is removed, a greater risk for electrolyte imbalance can occur. Diarrhea, excessive perspiration and vomiting can increase this risk. A person with short bowel syndrome is at high risk. Their electrolytes should be monitored closely. Your diet should include fluids and foods rich in electrolytes. A general rule is to ‘salt foods to taste.’ Do not exclude sodium in the diet.”1

“High output stoma is encountered with surgically created stomas such as ileostomy, jejunostomy, and colostomy. Different studies have defined a high ileostomy output as more than 1500 mL to 2000 mL per day with signs and symptoms of dehydration. Studies have indicated that almost 16% of patients develop a high output stoma, of which 27% need to be managed conventionally. This results in fluid and electrolyte imbalance culminating in a state of dehydration and acute kidney injury. Current management guidelines for high-output stomas focus on supportive measures and medications that decrease bowel motility. However, response to therapy is often variable and the plan needs to be modified based on the initial fluid status, electrolyte deficit, severity of dyselectrolytemia and response to antimotility agents.”2

The extraction of the large intestine impairs the body’s ability to assimilate electrolytes and nutrients. Therefore, people that have undergone ostomy diversion surgery, such as colostomy, ileostomy, and urostomy, are more prone to suffer electrolyte deficiencies. Especially those with an ileostomy or a urostomy need to watch for persistent diarrhea, vomiting, sweating, nausea, and high fever. 

Ostomy patients’ diets must ensure proper intake of fluids, as well as foods containing potassium and sodium. The latter ingredient is important, but it does not require major efforts to acquire as it is present in most foods. As a note of caution, if dizziness or signs of dehydration appear, immediately drink a sports drink or an electrolyte beverage. Use sports drinks only as a boost. Electrolyte drinks may be made at home with water, salt, salt substitute for potassium, and baking soda.

“You will need to drink plenty of fluids to avoid becoming dehydrated. The recommended amount is 2-2.5 liters per day (a minimum of 8 cups per day). If you are becoming dehydrated it can generally make you feel very unwell. Signs of dehydration include a dry mouth, headache, tiredness and low urine output (very little urine that is very dark). It is recommended that you should drink extra fluids during hot weather or exercise, or if you have a watery output. We recommend that you have isotonic drinks, which are higher in salt and sugar. Isotonic fluids are better for you because of the higher sodium (salt) and glucose content. They encourage fluid to be absorbed into your gut, rather than passing straight through into your stoma bag.” Dietary requirements for people with an ileostomy.”3

“Seven to eight liters of fluid enters the upper gut every day and most of it is reabsorbed in the jejunum and ileum. About 1-1.5 L enters the colon from the ileum and 150 to 200 ml is excreted as stool. When there is an ileostomy, the output depends on the length of the small bowel proximal to the stoma. The proximal bowel adapts to the fluid and electrolyte losses of the stoma. After a period of adaptation, the loss of electrolytes is reduced by about 70% and the output decreases to an average of 750 ml/day (10-15 mL kg-1 day-1). A high output stoma is defined as stomal output >l.5 L/day which subsequently causes dehydration and dyselectrolytemia. In the first three weeks following surgery, almost 16% of patients with a small bowel stoma have problems with high stoma output and 27% of these require long-term treatment. 

The effluent characteristics of an ileostomy are between normal ileal and fecal content. There is fluid and electrolyte loss as the small bowel is unable to conserve sodium, chloride, and bicarbonate leading to dehydration, hyponatremia and metabolic acidosis. Long-standing ileostomies also have hypomagnesemia and decreased absorption of vitamin B12 and folic acid. The psychological and practical difficulties of managing a high-output stoma should also be taken into account.”4

Ostomy Guide: Problems Related to Electrolyte Imbalances

Ostomy Guide - Problems Related to Electrolyte Imbalances
Ostomy Guide – Problems Related to Electrolyte Imbalances

Fluid and Electrolyte Problems

Fluid and Electrolyte problems.
Fluid and Electrolyte problems. (5)

“The large intestine does not play a major part in absorbing nutrients; although it absorbs some minerals, notably salt, its main job is to extract water from waste coming from the small intestine. If all or much of the large intestine is removed, the patient loses this natural ‘rehydrator’ and can be at risk for dehydration. Therefore, dehydration affects ileostomies more than any other type of ostomy. Physical activity (especially sports) and hot weather can increase the risk of dehydration. Thirst is not always an accurate measure of your body’s needs; those with ileostomies should develop the habit of drinking fluids throughout the day. (8 to 10 glasses per day is recommended). Ileostomates should make a habit of drinking more fluids per day than they did before surgery.”6

Ostomy Guide: Foods High in Potassium

  • Black-Eyed Peas
  • Bouillon
  • Fish
  • Pinto Beans
  • Tomato or Vegetable Soup
  • Watermelon
  • Bananas
  • Chicken
  • Oranges
  • Raisins
  • Veal
  • Yogurt

Ostomy Guide: Foods High in Sodium

  • Broth
  • Buttermilk
  • Canned Soups
  • Canned Vegetables
  • Soy Sauce
  • Cheese
  • Table Salt
  • Tomato Juice
  • Pickles
  • Commercially Prepared Foods

Preparing and Utilizing Electrolyte Drinks

“Excessive fluid loss of more than one quart of liquid stool in 24 hours can cause dehydration and require medical attention. (Normal ileostomy pouch emptying is five to eight times daily.) Balance intake of fluids with the output from the stoma. Water is an excellent natural beverage; however, over-consumption of water can wash away electrolytes in the body. Drink a combination of water and electrolyte beverages. The glucose ingredients in electrolyte drinks aid in the absorption of electrolytes. Foods with low osmolarity, which aids in maintaining fluid balance in the bowel, are best. A high sugar beverage may cause further fluid loss and dehydration. 

Homemade Electrolyte Drink Or Quick Fix 

  • 1 teaspoon salt
  • Orange juice – 4 ounces
  • 1 teaspoon baking soda
  • Water – 4 ounces
  • 1 teaspoon of white Karo syrup
  • A pinch of salt
  • 1 6-ounce can of frozen orange juice (add water to make one quart, mix well) 

Diluted Electrolyte Drinks (Brand Names) 

Improve taste, tolerance, lower calories, and decrease cost 

  • 1/2 quart (500 cc) – commercial electrolyte drinks
  • 1/2 quart (500 cc) – water
  • 1 teaspoon salt substitute (potassium chloride) Mix well”7

“Any liquid containing water (soda, milk, juice, etc.) helps to meet your daily requirement. You can also get water from the food you eat. (e.g., tomatoes have a 94 percent water content). Drinking coffee or tea will interfere with the ability to stay hydrated because they both cause the kidneys to increase urine and salt output. Be sure when drinking coffee or tea to increase your water consumption to counterbalance the higher output. Encourage fluid intake of eight to ten (8 oz.) glasses of liquids each day. Drinking more fluids is helpful in flushing out the kidneys, eliminating impurities in the blood, and helping you to maintain the proper electrolyte balance.”8

“Fluid and electrolyte disorders are a common cause of in-hospital morbidity. Prompt recognition and treatment of severe fluid and electrolyte abnormalities are vital in critically ill patients to avoid significant and potentially fatal complications. Appropriate management of these disorders requires determination of the underlying cause. Pharmacists can greatly impact the assessment and treatment of fluid and electrolyte disturbance in intensive care unit patients, particularly as it relates to the patient’s overall medication treatment plan.”9

“The proportion of ostomy patients who were readmitted with altered electrolyte balance and dehydration because of LHOS was 50 %, much higher than the 5.5 % reported by Baker, but similar to that reported in other studies, which have recorded 20–43 % of readmissions due to dehydration related to fluid losses through the stoma. An ileostomy is considered a risk factor for kidney failure”10

References:

(1, 5, 7, 8. Diet and Nutrition Guide. Pasia, M.  United Ostomy Associations of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/01/OstomyNutritionGuide.pdf

(2, 4) A systematic approach in the management of a high output ileostomy resulting in a favorable clinical outcome. Raju, D., Sheshagiri, N., Kadarapura, S., & Shenoy, S. Department of Anesthesia and Critical Care, Cytecare Hospital. 2018. https://www.pulsus.com/scholarly-articles/a-systematic-approach-in-the-management-of-a-high-output-ileostomy-resulting-in-a-favorable-clinical-outcome.pdf

(3) Dietary Requirements for people with an ileostomy. OUH Stoma/Colorectal Nursing Team. Oxford University Hospitals NHS Foundation Trust. 2016. https://www.ouh.nhs.uk/patient-guide/leaflets/files/13241Pileostomy.pdf

(6) A handbook for new ostomy patients.  Vancouver Chapter of Ostomy Canada Society. 2017. https://www.ostomyhamilton.com/wp-content/uploads/handbook/A%20Handbook%20for%20new%20ostomy%20patients.pdf

(9) Fluid and electrolyte management. Bartel, B., & Gau, E. Jones & Bartlett Learning. 2012. http://samples.jbpub.com/9781449604783/04783_ch07_pass01.pdf

(10) Protocol for the detection and nutritional management of high-output stomas. Arenas Villafranca, J., López-Rodríguez, C., Abilés, J., Rivera, R., Gándara Adán, N., & Utrilla Navarro, P. Nutritional Journal. 2015. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0034-z

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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