What is the ideal daily ileostomy output?

Ideal Daily Ileostomy Output

The ideal daily ileostomy output should be maintained between 500-700 mL per day (option A) to prevent dehydration and electrolyte imbalances while ensuring adequate nutrition and quality of life. 1

Understanding Ileostomy Output

An established ileostomy typically produces between 600-800 mL of output per day 2. This is significantly less than a newly formed ileostomy, which can initially produce around 1,200 mL of watery stool daily 2. Managing this output is critical because:

• High output (>1000-2000 mL/24h) increases risk of dehydration, electrolyte abnormalities, and malnutrition 1
• Output exceeding 2000 mL/24h puts patients at significant risk for serious complications 1
• Low output may indicate obstruction or inadequate fluid intake

Management Algorithm for Ileostomy Output

Step 1: Monitor Output Volume

• Measure daily stoma output volume
• Track weight, urine output (target ≥800 mL/day), and serum electrolytes 1
• Consider output >1000-1200 mL/day as high output requiring intervention 3

Step 2: Fluid and Dietary Management

• For normal output (500-700 mL/day):

  • Maintain 2-2.5 liters of fluid intake daily 1
  • Add 0.5-1 teaspoon of salt to meals daily 1
  • Balance hypotonic and isotonic fluids

• For high output (>1000 mL/day):

  • Restrict oral hypotonic fluids to <500 mL daily 4
  • Provide glucose-saline solution with sodium concentration ≥90 mmol/L (1-2L daily) 4, 1
  • Consider modified WHO cholera solution (60 mmol sodium chloride, 30 mmol sodium bicarbonate, 110 mmol glucose per liter) 4
  • Consume foods that thicken output: bananas, pasta, rice, white bread, mashed potato 1

Step 3: Pharmacological Interventions

• First-line: Loperamide 2-4 mg 30 minutes before meals (max 16 mg/day) 1, 5
• Second-line: Add codeine phosphate 30-60 mg four times daily if loperamide alone is insufficient 1
• For persistent high output: Consider antisecretory drugs like omeprazole 40 mg daily 4

Important Considerations and Pitfalls

1. Avoid excessive water intake without salt supplementation

   • Plain water increases sodium losses and worsens output 4, 1
   • Always balance fluid intake with appropriate sodium replacement

2. Rule out underlying causes of high output

   • Infections (including Clostridium difficile enteritis) 3
   • Partial bowel obstruction
   • Medication side effects
   • Recurrent disease in remaining bowel 4

3. Monitor for electrolyte imbalances

   • Hyponatremia, hypokalemia, and hypomagnesemia are common 4, 1
   • Correct magnesium deficiency to prevent resistant hypokalemia 4

4. Recognize early signs of dehydration

   • Decreased urine output (<800 mL/day)
   • Increased thirst
   • Dizziness or lightheadedness
   • Weight loss >5% of body weight

By maintaining ileostomy output in the ideal range of 500-700 mL/day, patients can minimize complications, reduce hospitalization risk, and maintain better quality of life.