From the Research
In pediatric patients with stomas, normal stoma output ranges from 20-40 ml/kg/day, with high output considered greater than 40 ml/kg/day and low output less than 20 ml/kg/day. These parameters are crucial for monitoring fluid balance and nutritional status in children with stomas. High output can lead to dehydration, electrolyte imbalances, and malnutrition, requiring prompt intervention with fluid replacement, electrolyte correction, and possibly medications like loperamide or octreotide to reduce output 1. Low output may indicate stoma obstruction or inadequate fluid intake. The specific values may vary slightly depending on the location of the stoma in the gastrointestinal tract, with more proximal stomas (such as jejunostomies) typically having higher outputs than more distal stomas (such as colostomies) 2.
Some key points to consider in managing pediatric patients with stomas include:
- Regular monitoring of stoma output, along with clinical assessment of hydration status and growth parameters, is essential for optimal management 3.
- Pharmacological options for the treatment of high-output stomas in children are limited, and evidence for their use is lacking, with proton pump inhibitors and loperamide being primary treatment suggestions 1.
- Subcutaneous octreotide can be administered when complications persist, and codeine may be used in rare cases in children over 12 years old, but addiction risk and side effects limit its use 1.
- The location of the stoma in the gastrointestinal tract can impact output, with more proximal stomas typically having higher outputs than more distal stomas 2, 4.
- Loperamide has been shown to reduce ileostomy output statistically significantly, but with varying effects among patients and without reaching the clinical significance of 20% set-up by some studies 5.
Overall, managing pediatric patients with stomas requires a comprehensive approach that includes monitoring of stoma output, assessment of hydration status and growth parameters, and potentially pharmacological intervention to reduce output and prevent complications 1, 2.