From the Guidelines
Octreotide is used in young children with high-output stomas to manage fluid and electrolyte losses, particularly in the short-term after intestinal resection, as it has been shown to reduce ileostomy diarrhea and large volume jejunostomy output. This is based on the most recent evidence from 2021, which suggests the use of octreotide in patients with high output jejunostomy in whom fluid and electrolyte management is problematic despite conventional treatments 1. The medication works by inhibiting gastrointestinal hormones, decreasing intestinal secretions, slowing intestinal motility, and reducing splanchnic blood flow.
Some key points to consider when using octreotide in this context include:
- Careful monitoring of patients treated with octreotide to prevent fluid retention and potential adverse effects, as well as potential negative interference with the process of intestinal adaptation during long-term use 1
- Measuring the effects of octreotide objectively and reducing parenteral support accordingly to avoid fluid retention 1
- Being aware of the potential beneficial effects of somatostatin on intestinal absorption, as well as the potential detrimental effects of interfering with the physiological process of adaptation to intestinal resection 1
In terms of dosing and administration, the evidence does not provide specific guidance, but typical dosing ranges from 1-10 mcg/kg/hour as a continuous intravenous infusion, though subcutaneous administration at 1-10 mcg/kg every 8-12 hours may also be used. Treatment duration varies based on clinical response but typically continues until stoma output decreases to manageable levels. It is essential to prioritize careful monitoring of fluid and electrolyte balance and vigilance for potential side effects when implementing octreotide therapy.
From the Research
Use of Octreotide in Young Children with Stomas
- Octreotide is used in some cases of high-output ileostomies in children, as it can help reduce ostomy output 2.
- The use of octreotide in pediatric patients is often based on data from adult studies or other intestinal failure conditions, as there is limited evidence on its use in children 2.
- Octreotide has been used to treat various gastrointestinal disorders in children, including massive gastrointestinal bleeding, pancreatic pseudocyst, and chronic diarrhea 3.
- Studies have shown that octreotide can be effective in reducing stool output in children with high-output ileostomies, although the evidence is limited and more research is needed 3, 4.
Mechanism of Action and Potential Benefits
- Octreotide is a somatostatin analogue that can help reduce gastrointestinal secretions and slow down intestinal motility, making it a potential treatment option for high-output ileostomies 3, 4.
- The use of octreotide in children with stomas may help reduce the risk of dehydration and electrolyte imbalances, and improve overall quality of life 2, 3.
- However, the use of octreotide in children also carries potential risks, including adverse events such as hyperglycemia, growth hormone deficiency, and hypertension 3.
Comparison with Other Treatments
- Other treatments, such as lanreotide, have also been studied for their potential use in managing high-output ileostomies in children 5, 6.
- However, the evidence on the effectiveness of these treatments is limited, and more research is needed to determine their potential benefits and risks 5, 6.
- Octreotide may be considered as an alternative or adjunctive treatment option for children with high-output ileostomies who do not respond to other treatments or have significant side effects 2, 3.