From the Guidelines
Patients with a urostomy, particularly those with short bowel syndrome and a jejunostomy, should use a glucose–electrolyte oral rehydration solution (ORS) to enhance absorption and reduce secretion, rather than drinking large quantities of water or other hypotonic fluids. This approach is crucial in maintaining adequate hydration and preventing fluid and electrolyte disturbances, as evidenced by the 2022 study published in Clinical Gastroenterology and Hepatology 1. The study highlights the importance of considering the sodium and glucose content of oral fluids, as inappropriate fluids can exacerbate fluid losses in patients with short bowel syndrome.
Key considerations for fluid intake in patients with a urostomy include:
- Limiting oral intake of low sodium, hypotonic solutions (e.g., water, tea, coffee, alcohol) and hypertonic solutions (e.g., fruit juices and sodas) to reduce output
- Using commercially prepared ORS products or homemade ORS recipes to enhance absorption and reduce secretion
- Maintaining a urine output of at least 1 L/d to ensure adequate hydration
- Monitoring urine output and color to detect signs of dehydration, such as dark, concentrated urine
It is essential to note that patients with a urostomy and a colon may be able to maintain adequate hydration with hypotonic fluids, but those with a jejunostomy and less than 100 cm of residual jejunum may require more careful management of fluid intake to prevent dehydration and electrolyte imbalances, as suggested by the study 1.
From the Research
Urostomy and Fluids
- Patients with urostomies or ileostomies are susceptible to fluid and electrolyte imbalances due to increased fluid losses 2.
- Maintaining a balance of fluid and electrolytes is crucial for the care of patients with urostomies, and healthcare practitioners must be aware of key monitoring and assessment parameters 3.
- There is no scientific evidence to support the recommendation to drink at least eight glasses of water a day for healthy adults in a temperate climate leading a sedentary lifestyle 4, 5.
- However, patients with certain medical conditions, such as kidney disease, may require increased fluid intake to slow disease progression 5.
- Electrolyte disorders, such as hypokalemia and hyperkalemia, can occur in patients with urostomies or ileostomies and require prompt management to prevent cardiac arrhythmias and other complications 2, 6.
Electrolyte Imbalances
- Hypokalemia and hyperkalemia can cause cardiac arrhythmias and muscle weakness or pain, and require different management strategies depending on the severity of the imbalance 6.
- Patients with urostomies or ileostomies are at risk for developing electrolyte and acid-base disorders, including metabolic acidosis and metabolic alkalosis, due to increased fluid and solute losses 2.
- Healthcare practitioners must be aware of the pathophysiological characteristics, diagnosis, and management of these disorders to provide effective care for patients with urostomies or ileostomies 2.