High Output Stoma UHL Nutrition and Dietetics Guideline

Guideline for Adults with a High Output Stoma (HOS)
A: 1200-1800ml/day B: >1800ml daily volume

Trust ref: B12/2005
1. Introduction
This guideline sets out the identification and management of patients with a high output stoma
including reducing and replacing fluid and electrolyte losses, drug management, nutritional support,
and on-going monitoring of an adult patient with a high output stoma.
There is no universal definition for when a stoma is considered to have a high output. Historically in
University Hospitals of Leicester NHS Trust (UHL) a high output stoma was defined as one which
produces more than 2000ml/day (for more than 3 days), or one in which the volume has not been
measured accurately or is producing less than 2000ml daily but there are on-going issues with fluid
and electrolyte balance.
Newly formed stoma with outputs of >1200ml daily can also cause problems such as acute kidney
injury and hyponatremia (sodium depletion) and often require patients to stay in hospital until
outputs reduce and/or result in readmission. This guideline provides management guidelines for
both groups.
2. Scope
2.1.1 This guideline applies to adult patients within UHL with an ongoing high stoma output,
irrespective of the patient’s clinical area or setting (inpatients, daycase, outpatients).
2.1.2 The aim of this document is to reduce complications of high output stoma by promoting
evidence based practice amongst medical, nursing and health care professionals working with
this patient population.
2.1.3 While the guideline is aimed at patients on surgical/medical wards, certain aspects (such as
the use of medication to reduce intestinal losses) are transferable to other areas, such as
critical care, oncology and medical admission areas.
2.1.4 The following professional groups are authorised to use this guideline:
 Surgical / medical teams
 Pharmacists
 Dietitians
 Nutrition Nurse Specialists
 Colorectal and Stoma Care Nurse Specialists.
3. Recommendations, Standards and Procedural Statements

3.1 A high output stoma occurs in situations of intestinal failure when there is reduced intestinal
absorption so that macronutrient and/or water and electrolytes are needed to maintain
health/growth (Nightingale, 2001). Common causes include extensive bowel resection
(secondary to Crohn’s disease, Bowel ischaemia) and chronic impairment of bowel function
(such as radiation enteritis, dysmotility disorders).
3.2 Potential causes of a high output stoma must be considered and treated as appropriate.
Sepsis, sub-acute obstruction, steroid withdrawal (following surgery for inflammatory bowel)
and clostridium difficile infection can all cause a high stoma output and should be excluded as
the cause (Baker et al, 2010).
3.3 Treatment strategies for the management of intestinal failure involve treating sepsis/intra-
abdominal abscesses, reducing the stoma output, replacing fluid and electrolyte losses,
providing nutritional support, wound care, and psychological support.
Guideline for the management of Adult Patients with a High Output Stoma Page 1 of 14
V5 Approved by Policy and Guideline Committee on 16th April 2021 Trust Ref: B12/2005 Next Review: May 2024
NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents
3.4 Patients require a multidisciplinary team approach to management. Patients may require
referral to the Leicester Intestinal Failure Team (LIFT) on ICE/NerveCentre.The majority of
patients have a transient post-operative high output stoma that will normalise. Treatment
though may be required long term or, in some cases until further bowel surgery is possible (to
reserve the stoma).
3.5 These guidelines refer to stoma outputs of 1200 – 1800ml daily (A) and more than 1800ml
daily (B). A patient with a newly formed ileostomy will be expected to produce between 500-
2000ml daily (Condon, 1993). Adaptation occurs over weeks/months to produce a porridge-
like stool of about 600ml daily (Hughes et al, cited Nightingale 2001). Volume of stoma output
will be dependent on length of small bowel remaining and other factors (such as intra-
abdominal sepsis).
3.6 Any patient with a stoma output of more than 1000ml daily should be referred to the stoma
care nurses for advice on appliances / management. A well fitting appliance promotes skin
integrity, allows for accurate recording of fistula/ostomy output, limits cross infection and
reduces odour. It also avoids the use of dressings, maintains patient mobility, helps patients
regain their confidence and quality of life as well as being a cost-effective procedure (Black,
2000).
3.7 Table 1 provides a general guide to when requirements for additional fluids/electrolytes and
nutrition are required.
Table 1. Stoma Positioning and Requirement for fluids/electrolytes
Small bowel length to stoma.
Requirement for fluids and nutrition
(daily volume) Guideline
0-100cm Parenteral Nutrition + additional saline (+
(Expected volume 2-4litres daily) Magnesium) HOS (B) for
stoma outputs
101-150cm
May need IV fluid & electrolytes plus Oral >1800ml/day
(expected volume > 2000ml
glucose-electrolyte solution
daily)
151-200cm May need IV fluid & electrolytes plus Oral
(expected volume 2000ml daily) glucose-electrolyte solution
>200cm Oral glucose-electrolyte solution (May need
(If volume >2000ml daily) IV fluid & electrolytes)
HOS (A) for
>200cm
stoma outputs
(volume >1200ml – 2000ml May require oral Glucose-electrolyte solution
1200 -1800ml/day
daily)
>200cm Normal fluids and high salt diet should be N/A

(but volume <1200ml daily) sufficient standard care
Adapted from Nightingale & Woodward, 2006
3.8 Local and national data (Baker et al, 2016: Cunha et al 2015:Hayden et al, 2013) suggests
readmission rates in the region of 20% after ileostomy formation due to complications of
stoma outputs causing acute kidney injury. Education and training of patients and their
carers is vital before discharge from hospital.
Procedures / Further Information
No. Action
1 Summary Guidance
2 Management of Fluid and Electrolytes in a patient with a high output stoma
3 Medication to Reduce a High Output Stoma
4 Nutritional Support for Patients with a High Output Stoma
5 Monitoring patients with a High output stoma and ongoing referral
6 Post Discharge Review Proforma
7 St Marks Solution Instructions
4. Education and Training

The professional staff authorised to use this guideline as detailed in section 2 must have received
relevant training in this patient population and accept responsibility for updating knowledge and
skills on a regular basis to maintain competence. LIFT offer regular training to teams such as
colorectal surgical doctors and can provide training to relevant clinical areas / specialities on
request.
5. Monitoring Compliance
What will be measured to How will compliance be Monitoring Reporting
Frequency
monitor compliance monitored Lead arrangements
Post-discharge follow up Audit (identified from those Clinical Biannually Via
arrangements for those with a discharged on oral Lead LIFT CHUGGS,
High output stoma rehydration (St Marks) CSI
and/or loperamide dose
above 12mmol QDS)
NB Two previous audits completed of compliance, with guideline updated post this and training and
education provided.
6. Supporting References Other references available on request

Baker M L, Williams R N & Nightingale JMD (2011) Causes and management of a high-output stoma,
Colorectal Diseases, 13(2);191-7
Hayden DM, Pinzon MCM, Francesiatti AB et al (2013) Hospital Readmission for Fluid and Electrolyte
Abnormalities Following Ileostomy Construction: Preventable or Unpredictable? Journal of Gastrointestinal
Surgery 17:298-303
Jeppesen PB, Staun M, Tjellesen L, et al. Effect of intravenous ranitidine and omeprazole on intestinal
absorption of water,sodium, and macronutrients in patients with intestinal resection. Gut 1998;43:763–9.
Kristensen K, Qvist N. The acute effect of loperamide on ileostomy output: a randomized, double-blinded,
placebo-controlled, crossover study. Basic Clin Pharmacol Toxicol 2017;121:493–8.
Nightingale JMD, How to manage a high-output stoma, Frontline Gastroenterology, Published Online
First: 22 March 2021 doi: 10.1136/flgastro-2018-101108
Nightingale JM, Lennard-Jones, JE, Walker ER, et al. Oral salt supplements to compensate for jejunostomy
losses:comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte
solution. Gut1992;33:759–61.
Nightingale J & Woodwood JM,Guidelines for management of patients with a short bowel, Gut 2006;55(Suppl
IV):iv1–iv12
Rodrigues CA, Lennard-Jones, JE, Thompson DG, et al. What is the ideal sodium concentration of oral
rehydration solutions (ORS) for short bowel patients? Clinical Sciences 1988;74:69.
7.Keywords
HOS (High output stoma),LIFT (Leicester Intestinal Failure Team) ileostomy, Jejunostomy,Intestinal
failure
DEVELOPMENT AND APPROVAL RECORD FOR THIS DOCUMENT

Author / Lead Officer: Melanie Baker, Job Title: Clinical &Specialty Lead,
Nutrition Support Team
Reviewed by: UHL Leicester Intestinal Failure MDT
Approved by: Policy and Guideline Committee Date Originally Approved: 10 January 2005
REVIEW RECORD
Date Issue Reviewed By Description Of Changes (If Any)
Number
March 2021 V5 Melanie Baker Format update-
-
Removal of Glucodrate as no longer available
2017 V4 Melanie Baker -
Pathway for stoma outputs 1200 – 1800ml included
-
Guidance on post discharge follow up included
-
Second line oral rehydration Glucodrate use if non-
compliance with St Marks and patient under the care of the
Leicester Intestinal Failure Team (LIFT)
2013 V3 Melanie Baker - Summary, traffic light sheet made clearer so that care
increases in a step wise manner post audit.
- Additional information included about other types of glucose-
electrolyte solutions available (St Marks with sodium Citrate).
- Additional clarification about use of St Marks solutions,
especially in patients with very short remaining length of
bowel.
- Format changed in accordance with Trust policy.
DISTRIBUTION RECORD:
Date Name Dept Received
Jan 2021 UHL Leicester Intestinal Failure Team Dietetics & Nutrition Service.CSI
Gastroenterology, CHUGGS
Feb Colorectal Surgeons and GI Surgical Gastro-intestinal Surgery, CHUGGS
Registrars
Summary Guidance for stoma outputs
1200-1800ml daily (A) Appendix 1
STAGE A1: Initial management

DO NOT INSTIGATE IN THE FIRST 48hours POST STOMA FORMATION
1. Confirm stoma output is 1200 – 1800ml via STRICT 24hour fluid balance
2. Commence loperamide 2 mg QDS to reduce stoma losses.
This should be given 30-60minutes before meals and at bedtime (if using capsules
open and mix with jam/yogurt. Once gut transit time has been reduced whole
capsules can be swallowed and the effect on stoma output monitored).
Loperamide dose can be increased by 2mg QDS every 24hours. Review effect
on stoma output before increasing to 8 mg QDS.
3. Monitor strict fluid balance, daily weights, and serum U&E, AKI staging, and
magnesium levels. Supplement if required.
4. Encourage normal oral fluids and a high salt diet. Do not restrict hypotonic fluids
or start oral rehydration initially. Refer to Dietitian if nutritional intake poor.
STAGE A2: Review after 3 days

If output <1500ml/d No If output 1500-1800ml If output >1800ml
further action Follow below Follow HOS B guidance
1. If output >1500ml daily on 8mg loperamide QDS review proton-pump inhibitors.

Initiate or change to Esomeprazole/Omeprazole40 mg OD-BD to reduce volume of
gastric secretions and stoma volume.
2. Commence oral rehydration solution St Marks 1000ml daily and restrict all other
fluids to 500ml daily.
3. Review:
- If output reduces aim to increase oral fluids gradually and reduce loperamide dose
as output thickens.
- If output remains >1500ml aim to maintain hydration and sodium balance off IV
saline (urine output >1000ml daily and urine sodium > 20mmol/l).
Summary Guidance for stoma outputs
Greater Than 1800ml daily (B)
If output > 3000ml place patient NBM for 24-48 hours to assess baseline gastrointestinal
secretions. NB In patients with very short bowel <100cm to stoma d/w Leicester Intestinal
Failure Team (LIFT). Total oral fluid restriction and reducing gastric secretions are key
DO NOT INSTIGATE IN THE FIRST 48hours POST STOMA FORMATION
CHECK FOR SEPSIS, SUB ACUTE OBSTRUCTION, STEROID WITHDRAWAL AND

INFECTION (Send culture) AS POTENTIAL CAUSES.
STAGE 1: Initial management – Reduce fluid and electrolyte losses
 Restrict ORAL FLUIDS to 500ml daily.

 Commence loperamide 4mg QDS to reduce stoma losses. This should be given
30-60minutes before meals and at bedtime (if using capsules open and mix with
jam/yogurt)
 Monitor strict fluid balance, daily weights, serum U&E, AKI staging and magnesium
levels. Supplement fluid and electrolytes IV as required.
Review stoma output after 48 hours – if output now <1800mls increase oral fluid
intake and follow plan A
STAGE 2: Ongoing output >1800ml/day – optimise treatment with
anti-secretory / diarrhoeal medication
 Continue oral fluid restriction and check compliance.
 Commence St Marks oral rehydration solution 1000ml daily, in addition to oral
fluid restriction (this replaces stoma sodium losses but will still increase output if
taken in excessive amounts). Once IV fluids are stopped, check random urine
sodium (aim >20mmol/l).
 Review proton-pump inhibitors. Initiate or change to Esomeprazole/Omeprazole
40 mg OD-BD to reduce volume of gastric secretions and stoma volume.
 Increase loperamide dose to 8mg QDS
 Add in codeine phosphate 15mg – 60mg QDS, 30-60minutes before meals (use
cautiously in patients with renal impairment and contraindicated if GFR<15).
STAGE 3: REFER TO LIFT on ICE if HOS continues
 loperamide dose can be increased by 2-4mg (re-assess every 2-3days. Only

increase further if a significant improvement in output is seen. Maximum dose is
24mg QDS but >12/16mg QDS rarely required).
 If stoma output remains >2000ml daily after 2weeks of therapy can trial octreotide
200microgrammes TDS for 3-5 days. If no significant improvement stop. If
improvement consider longer-term analogues.
 Review compliance to oral fluid restriction and St. Marks solution.
 Continue strict monitoring (fluid balance charts, weights, weekly magnesium levels).
Management of Fluid and Electrolytes in
stoma outputs >1800ml daily Appendix 2
1.1 The initial management of a high output stoma should concentrate on reducing fluid and
electrolyte losses. Restricting oral intake is the main stay of treatment, with intravenous
replacement of fluid and electrolyte losses as required.
Stage 1: Initial Management: Reduce Fluid and Electrolyte Losses:

Review oral fluid intake Rationale
Restrict ORAL FLUIDS (such as water, tea, Fluids with a sodium concentration of <90mmol/l will
squash) to 500ml daily. cause a net secretion of sodium from the blood to
the gut lumen and this is lost via the stoma
(Rodrigues C et al, 1988).
If stoma output is >3000ml/day place the patient Gastrointestinal secretions (4000ml/24hrs) will be
NBM for 24hours to assess gastrointestinal reduced with no oral intake. This may be beneficial
secretion. as a short term measure, if initial stoma output is
>3000ml daily. This will help improve hydration
status and also assess if the high output is due to
excessive secretion of gastrointestinal fluids.
Review the need for intravenous fluids to Ileostomy output contains approximately 1000mmol
maintain hydration and replace stoma losses. of sodium per litre (Nightingale, 2021)
Fluids with adequate sodium should be given in
depleted patients.
If high stoma losses continue on antidiarrhoeal There is a coupled absorption of glucose and
medication, commence St. Marks glucose- sodium in the jejunum (Olsen, 1968). Sodium
electrolyte replacement solution 1000 ml daily, concentrations >90mmol/l result in sodium
orally (See appendix 5) absorption and improve sodium balance
(Nightingale et al 1992).
NB - St Marks solution should not be given in
unrestricted amounts as excess consumption will St Marks solution does not reduce stoma volume
still increase stoma volume. per se when compared to the same quantity of
water consumed (Nightingale et al, 1992) It
improves sodium balance, which in turn improves
thirst, so that overall fluid intake can be reduced
(when used in conjunction with a hypotonic fluid
restriction). This will then reduce stoma output.
In patients with very short proximal lengths of bowel

(<50cm to stoma) total fluid volume, including St
Marks should be restricted if stoma output needs to
be controlled.
Ongoing need for Intravenous replacement of To prevent electrolyte abnormalities and renal
fluid, sodium (and other electrolytes) must be impairment.
considered. Some patients may require
ongoing/home IV fluids or home parenteral
nutrition (ref to Leicester Intestinal Failure Team)
Appendix 4
1.2 Oral Rehydration Solutions
a) Compliance to oral electrolyte solutions can be a problem.
b) First line oral rehydration is St Marks Solution 1000-2000ml given daily. If compliance to
taste is an issue in long term use than the sodium bicarbonate can be replaced with an
equivalent amount of sodium bicarbonate.
c) Dioralyte is not recommended as first line due to the cost and low sodium content – it
needs to be given at double strength (10 sachets In 1000ml) and this can lead to
problems with hyperkalaemia.
d) Isotonic re-hydration fluids such as Lucozade should not be used to replace St. Marks
Solution as the sodium concentration is too low.
1.3 Management of electrolyte abnormalities.

Electrolyte abnormalities are common in patients with a high output stoma, particularly
hypomagnesaemia. Magnesium deficiency occurs due to a combination of factors:
a) Bowel Resection – Magnesium is normally absorbed by passive diffusion in the small
bowel and colon. Resections reduce the absorptive area, although Mg balance is not
related to the length of bowel remaining.
b) Fatty Acids – from dietary fat or bacteria fermentation of unabsorbed carbohydrate, bind
with magnesium and prevent absorption.
c) Dehydration – Loss of salt and water causes hyperaldosteronism, which increases the
absorption of sodium at the expense of Potassium and magnesium (increased renal
excretion of magnesium).
d) Vitamin D – if hypomagnesemia persists then check serum Vitamin D levels.
Magnesium should be supplemented following UHL Hypomagnesaemia guidelines (UHL
Ref C10/2002)
Medication to Reduce High Output Stoma
Volume Appendix 3
Stage 1: Commence anti-diarrhoea Rationale

medication
Commence loperamide 4mg QDS to Loperamide can reduce intestinal motility and thus
reduce stoma losses. decrease ileostomy output by 20-30% ( Kristensen et al,
This should be given 30-60minutes prior to 2017) Loperamide has benefits over codeine phosphate
meals and at bedtime (if using capsules and should therefore be the first choice of anti-diarrhoea
open and mix with jam/yogurt). medication (Loperamide is not sedative, addictive and
does not cause fat malabsorption).
NB This may not be effective in patients

with very short bowel (<50cm to stoma).
Review medication and aim to stop any
medications which can increase stoma
output (such as prokinetics).
Stage 2: Optimise treatment - Anti- Rationale
secretory, anti-diarrhoeal medication
Increase loperamide dose to 8mg QDS. Loperamide doses above recommended and licensed
doses are often needed in patients with intestinal failure,
as absorption is reduced (both due to reduced surface
area and altered enterohepatic circulation). Higher
plasma levels are needed to control a high output stoma
than in the treatment of acute diarrhoea.
Review proton-pump inhibitors. Omeprazole has been shown to reduce jejunostomy
Give Esomeprazole/Omeprazole 40 mg output. (Jeppesen et al, 1998). This can be given orally if
OD (increasing to BD if output remains >50cm jejunum remains, as it is readily absorbed in the
above 2000ml/d when other measures duodenum and upper small bowel (by giving omeprazole,
above in place). gastric secretion is reduced, decreasing the osmotic
pressure on the intestine).
Add in codeine phosphate 15mg – 60mg Codeine phosphate in combination with loperamide
QDS, 30-60minutes prior to meals. reduces stoma volume. It should be used cautiously in
patients with renal impairment and is contraindicated in
patients with GFR <15.
Stage 3: Increase medication and Rationale
evaluate efficacy of other options
Increase loperamide dose by 2-4mg (effect Loperamide doses above recommended and licensed
of this should be assess for 2-3 days doses are often needed in patients with intestinal failure.
before increasing the dose further as BSG guidelines recommend a maximum dose of 24 mg
significant additional benefit may be QDS (Nightingale and Woodwood, 2006).but this should
unlikely above 8mg QDS). Maximum dose only to used in cases where the effect of low doses has
24mg QDS. been properly considered.
Significant further benefit is often unlikely above 32mg
daily (Carlson et al, 2010)
If stoma output remains >1800ml daily after Subcutaneous octreotide 50micrograms twice daily
2 weeks of therapy try sub/cut octreotide reduces ileostomy/jejunostomy outputs (Nightingale et al,
50-200microgrammes TDS. Give for 3-5 1989) by reducing salivary, gastric and pancreatico-biliary
days. If no improvement stop. secretions and slowing bowel transit. Longer acting
analogues may also be useful. It may not be more
effective than high dose loperamide and a proton pump
inhibitor so these options should be considered first.
Nutritional Support for Adult Patients with
a High Output Stoma Appendix 4
1) This patient population is at risk of malnutrition due to their underlying disease process
(cancer, inflammatory bowel disease) and treatment (often referred after surgery where
nutritional intake has been compromised).
2) All patients should be nutritionally screened on admission to hospital and monitored

regularly as per UHL policy.(Nutritional Screening and First Line Oral Nutritional Care Policy
for Adults. Trust Ref B26/2015). If patients are unable to meet their nutritional requirements
orally, enteral/parenteral nutrition should be considered and the patient referred to the
Dietetic department ICE/Nerve Centre for assessment.
3) For those patients where enteral nutritional support is deemed inappropriate (malabsorption
will limit effectiveness of treatment and exacerbate stoma losses), Parenteral Nutrition
should be considered. Patients should be referred to the Leicester Intestinal Failure Team
(LIFT) Nutrition Support Team for assessment via ICE/Nerve Centre.
4) If patients are unable to maintain their nutritional status due to an inadequate nutritional
intake, naso-gastric feeding should be considered. Enteral feeding formulations are low in
sodium and normally need to be given in volumes of 1 -2 litres/day. This will compound
stoma sodium losses. Solutions with low sodium concentrations lead to net secretion of
sodium (Spiller et al, 1987).
Monitoring patients with a High output
stoma and ongoing referral Appendix 5
4.1 Monitoring is vital to assess compliance and effectiveness of treatment.

Parameter Rationale
Ensure strict 24 hour fluid balance charts To aid in the assessment of stoma losses and hydration
are completed. status.
Assess compliance to hypotonic fluid Non compliance to oral fluid restriction causes
restriction and St Marks solution. dehydration (Baker, 2003). The LIFT Nutrition Team can
support with methods to improve compliance.
Weigh patient DAILY. Fluid balance charts derived from input-output charts are
notoriously inaccurate, with no measure of insensible
losses. Regular weight measurements are the best
serial measure of fluid balance assuming 1kg = 1 litre
(Lobo, 1999).
Monitor serum Urea and electrolytes, To monitor hydration and electrolyte status
including magnesium.
+
Monitor sodium balance once off IV Urine Na < 20 mmol/l reflects avid renal sodium
+
saline. Check random urine [Na ]: a level retention as a result of hypovolaemia (Kennedy, 1983).
<20mmol/litre indicates sodium depletion.
4.2 To assist with compliance by patient and health care professional involved in the care of a
patient with a high output stoma a ward based management guide is available (see page 3 &
4Summary Guidance on the Management of a High Output Stoma. These should be used to
reduce the risk of different teams/individuals giving different advice especially around the use of
St Marks and hypotonic fluid restrictions. Patient information leaflets are also available
(Managing with a High Output Stoma).
4.3 Local audit has identified that approximate half of patients presenting with a high output stoma
settle within 2 weeks (Baker et al, 2010). Patients with small bowel lengths of <150cm are likely
to have ongoing problems with a high output stoma. The need for antimotility drugs, hypotonic
fluid restriction and electrolyte replacement should be titrated depending on stoma
output/consistency and serum/urine measurements.
4,4 Local and national guidance suggests 20% of ileostomy patients are readmitted due to acute
kidney injury and hyponatraemia following hospital discharge. All patients should be educated
on signs and symptoms of dehydration and methods to replace fluid and sodium losses. Patient
information sheets are available. On discharge from hospital patients should have an
appropriate plan for follow-up in place. This should involve regular biochemical monitoring (via
GP) and clinical review. The LIFT can offer ongoing monitoring via outpatient clinics in required.
Post Hospital Discharge monitoring for those with a High Output Stoma (or post readmission
with AKI)
Monitor serum biochemistry U&E, Magnesium 1 – 2 weeks post discharge. If show

signs of AKI, hypernatremia clinical review required (see
appendix 6 for proforma
Post Hospital Discharge Stoma Review
Appendix 6
Patient Name:
S Number:
Date of Birth:
Surgical Procedure: Date of Surgery:
Length of small bowel

Relevant PMHx
Relevant issues related to stoma function during hospital stay:

High output stoma Yes / NO
Discharged on medication YES / NO
Current Medication Regime:

o PPI: YES / NO Regime:
o Loperamide: YES / NO Dose:
o Codeine: YES / NO Dose:
o Hypotonic Fluids (Volume per 24 hours):
o Oral Rehydration solution: YES / NO Volume per 24 hours:
Weight: Height: BMI:
Weight change from pre-surgery:
Recent weight change:
Fluid Balance
Fluid intake Urine – passing adequate volume Y / N
Stoma – Consistency
Emptying during the day x ______
Emptying at night _______
Signs of Dehydration / Hypernatremia

Thirst Skin Low Urine Output
Dizzy on standing (Postural Hypotension)
Plan
Action Required YES/NO
IF Yes
Fluid regimen advised YES / NO If so what
Medication Review YES / NO
Serum Biochemistry checked (U&E, Mg) YES / NO
Urine Biochemistry checked (Random urine electrolytes) YES / NO
If patient malnourished or requiring dietary advice, refer to Nutrition & Dietetic Dept
Follow-up plan
St Marks Instructions for Oral Hydration /

Electrolyte Replacement Appendix 6
Name …………………………… Date………………..
You have been prescribed St Marks Electrolyte mix. You will need to make up a fresh
solution each day .
Page 13 of 14
If Guideline
no
V5
for the management of Adult Patients with a High Output Stoma
compliance
Approved to HOS
by Policy and Guideline thtreatment
Committee on 16 April 2021 or more
Trust than
Ref: B12/2005 1 re-admission refer to LIFT teamMay(on
Next Review: 2024
ICE) NB: forPaperMDT Review
copies of this document may not be most recent version. The definitive version is held on INsite Documents
St Marks Oral Re-hydration Solution
Instructions Appendix 7
Measure the following ingredients :

20g Glucose powder with vitamin C - SIX level 5ml spoonfuls
3.5g Table Salt - ONE level 5ml spoonful
2.5g Sodium bicarbonate powder - ONE heaped 2.5ml spoonful or half a 5ml
spoonful
1Litre Water
Directions
• 5ml spoon is equivalent to a standard tea spoon
• Mix to dissolve all powder ingredients in one litre of water.
• Use within 24 hours and discard any remaining solution after this time.
• This solution may be diluted with a little fruit squash and refrigerated to make it
more palatable (make sure the total volume of water and squash is one litre).
• Glucose powder and sodium bicarbonate powder (also known as bicarbonate of
soda) is inexpensive and can be bought from any chemist or is available on
prescription from GP.
• Standard table salt available from any supermarket is suitable for use.
• In an emergency situation double strength Dioralyte may be used as a substitute.
Drink ……………… litre(s) of this mixture throughout the day.
If you need to get these prescribed please show your GP/Doctor this leaflet. They will need
to be prescribed in the following way.
St. Marks electrolyte mix

Formula Glucose 20g
Sodium chloride 3.5g
Sodium bicarbonate 2.5g Made up to 1L with tap water daily
Supply Glucose powder with Vitamin C 500g

Sodium chloride powder (table salt) 500g
Sodium bicarbonate powder 100g
If the prescription is written in this way, your community pharmacist can claim for
these items and will be able to supply them to you.
If you have queries, contact : ___________________________________

High Output Stoma UHL Nutrition and Dietetics Guideline

Uploaded by

Copyright:

Available Formats

High Output Stoma UHL Nutrition and Dietetics Guideline

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

High Output Stoma UHL Nutrition and Dietetics Guideline

Uploaded by

Copyright:

Available Formats

Guideline for Adults with a High Output Stoma (HOS)

A: 1200-1800ml/day B: >1800ml daily volume

3. Recommendations, Standards and Procedural Statements

>200cm Normal fluids and high salt diet should be N/A

4. Education and Training

6. Supporting References Other references available on request

DEVELOPMENT AND APPROVAL RECORD FOR THIS DOCUMENT

STAGE A1: Initial management

2. Commence loperamide 2 mg QDS to reduce stoma losses.

STAGE A2: Review after 3 days

1. If output >1500ml daily on 8mg loperamide QDS review proton-pump inhibitors.

CHECK FOR SEPSIS, SUB ACUTE OBSTRUCTION, STEROID WITHDRAWAL AND

 Restrict ORAL FLUIDS to 500ml daily.

 loperamide dose can be increased by 2-4mg (re-assess every 2-3days. Only

Stage 1: Initial Management: Reduce Fluid and Electrolyte Losses:

In patients with very short proximal lengths of bowel

1.3 Management of electrolyte abnormalities.

Stage 1: Commence anti-diarrhoea Rationale

NB This may not be effective in patients

2) All patients should be nutritionally screened on admission to hospital and monitored

4.1 Monitoring is vital to assess compliance and effectiveness of treatment.

Monitor serum biochemistry U&E, Magnesium 1 – 2 weeks post discharge. If show

Surgical Procedure: Date of Surgery:

Length of small bowel

Relevant issues related to stoma function during hospital stay:

Current Medication Regime:

o Loperamide: YES / NO Dose:

o Codeine: YES / NO Dose:

o Hypotonic Fluids (Volume per 24 hours):

o Oral Rehydration solution: YES / NO Volume per 24 hours:

Signs of Dehydration / Hypernatremia

Medication Review YES / NO

Serum Biochemistry checked (U&E, Mg) YES / NO

Urine Biochemistry checked (Random urine electrolytes) YES / NO

St Marks Instructions for Oral Hydration /

Name …………………………… Date………………..

Measure the following ingredients :

Drink ……………… litre(s) of this mixture throughout the day.

St. Marks electrolyte mix

Supply Glucose powder with Vitamin C 500g

If you have queries, contact : ___________________________________

You might also like