From the Guidelines
A high-output stoma is generally defined as an effluent of more than 2000 mL/24 h, while a normal output ranges from 500-1500 mL per day for an ileostomy, and low output is considered less than 500 mL per day. The definition of high-output stoma is crucial as it can lead to dehydration, depletion of sodium and magnesium, and malnutrition if not properly managed 1.
Key Points to Consider
- High-output stomas are most commonly seen in jejunostomy patients and are unlikely to occur in those with a colostomy with retained small bowel 1.
- When output is >2000 mL/24 h, electrolyte deficiencies due to a combination of reduced absorption and increased renal excretion should be replaced orally, or by intravenous supplementation if insufficient 1.
- Laboratory investigations include serum urea and creatinine, sodium, potassium, magnesium, and urinary sodium, with a random urinary sodium <20 mmol/L suggesting sodium depletion 1.
- Management of high output may include oral rehydration solutions, anti-diarrheal medications, and dietary modifications such as eating small, frequent meals, avoiding high-fiber foods, limiting hyperosmolar fluids, and ensuring adequate salt intake.
- For low output, increasing fluid intake, reviewing medications that may cause constipation, and gentle physical activity can help.
Important Considerations
- The variation in stoma output reflects the different absorptive functions of the remaining intestine, with more proximal stomas (like ileostomies) typically producing higher, more liquid output than distal stomas (like sigmoid colostomies) 1.
- Patients with high-output stomas should also be assessed for vitamin B12 and iron deficiency and provided with replacement therapy if required, as well as consideration for selenium, zinc, and vitamin A, D, E, and K deficiencies 1.
From the Research
Stoma Output Classification
- High stoma output is generally considered to be greater than 1.5-2.0 L/24 hours, although this can vary depending on the amount of food and drink taken orally 2.
- Normal stoma output is not explicitly defined in the provided studies, but it can be inferred that it is lower than high-output stoma.
- Low stoma output is not defined in the provided studies, but it is likely to be less than the normal output range.
Factors Affecting Stoma Output
- The amount of food and drink taken orally can affect stoma output, with high-output stomas often requiring restriction of hypotonic fluids and dietary modifications 3, 2.
- The length and quality of the remaining small bowel can also impact stoma output, with shorter lengths of functioning jejunum often requiring parenteral support 2.