What is the recommended ileostomy output to be maintained?

Recommended Ileostomy Output Volume

The optimal ileostomy output to be maintained is 500-700 mL per day to prevent dehydration and electrolyte imbalances while ensuring adequate nutrition and quality of life. 1

Understanding Ileostomy Output

Ileostomy output varies based on several factors:

• Recently formed ileostomies may produce approximately 1,200 mL of watery stool per day 2
• An established ileostomy typically produces between 600-800 mL per day 2
• High output is generally defined as >1000-2000 mL/24h 1
• Outputs exceeding 2000 mL/24h significantly increase risk for dehydration, electrolyte depletion, and malnutrition 1

Management of Ileostomy Output

For Normal Output (500-700 mL/day):

• Maintain 2-2.5 liters of fluid intake daily (more during hot weather or exercise)
• Add 0.5-1 teaspoon of salt to meals daily
• Monitor weight, urine output, and serum electrolytes regularly
• Target urine output ≥800 mL/day with sodium >20 mmol/L 3, 1

For High Output (>1000 mL/day):

1. Restrict oral hypotonic fluids to <500 mL daily 3, 1

   • This is the most important measure (grade B evidence) 3

2. Provide glucose-saline solution with sodium concentration ≥90 mmol/L 3, 1

   • Modified WHO cholera solution or alternative rehydration solution (see table below)
   • Most stomal losses have sodium concentration of about 100 mmol/L

3. Administer anti-motility medications:

   • Loperamide 2-8 mg before meals (non-sedative and non-addictive) 3, 1
   • Consider adding codeine phosphate if loperamide alone is insufficient 3, 1

4. For "secretory" output (>3 L/24 hours):

   • Add drugs that reduce gastric acid secretion (H2 antagonists or proton pump inhibitors)
   • Consider octreotide if unable to absorb oral drugs 3

Rehydration Solutions

Solution Type	Composition
Modified WHO cholera solution	60 mmol sodium chloride, 30 mmol sodium bicarbonate, 110 mmol glucose per liter [3,1]
Alternative rehydration solution	120 mmol sodium chloride, 44 mmol glucose per liter [3]

Common Pitfalls to Avoid

1. Excessive water intake without sodium replacement

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

2. Failure to recognize underlying causes of high output

   • Intra-abdominal sepsis
   • Partial/intermittent bowel obstruction
   • Enteritis (e.g., Clostridium difficile) 4
   • Recurrent disease in remaining bowel
   • Abrupt discontinuation of medications 3, 1

3. Inadequate monitoring of electrolyte imbalances

   • Hyponatremia, hypokalemia, and hypomagnesemia are common 1
   • Correcting magnesium deficiency is crucial to prevent resistant hypokalemia 3, 1

4. Ignoring ileal resection impact

   • Patients with significant ileal resection (30-120 cm) typically have much higher outputs (average 1202 mL vs 401 mL) compared to those with minimal resection 5
   • These patients require more aggressive management

Monitoring Parameters

• Daily stoma output volume
• Body weight
• Urine output (target ≥800 mL/day)
• Serum electrolytes, urea, creatinine, and magnesium
• Signs of dehydration (increased thirst, dizziness, weight loss >5%)

By maintaining ileostomy output in the recommended range of 500-700 mL per day, patients can achieve optimal hydration status, minimize complications, and maintain quality of life.