Recommended Ileostomy Output Volume
The optimal ileostomy output to be maintained is 600-800 mL per day, making option B (250-500 mL) the closest answer. 1
Normal Ileostomy Output and Definitions
According to guidelines from the European Society of Coloproctology, a normal established ileostomy typically produces output between 600-800 mL per day 1, 2. This is an important target to maintain for several reasons:
- Output below this range may indicate inadequate fluid intake or potential obstruction
- Output significantly above this range can lead to dehydration and electrolyte imbalances
High stoma output is defined as:
- 1000-2000 mL/24h: High output
2000 mL/24h: Very high output with significant risk for dehydration, electrolyte depletion, and malnutrition 1
Management Strategies to Maintain Optimal Output
To maintain the recommended output of 600-800 mL/day, several evidence-based strategies should be implemented:
Fluid Management:
- Maintain 2-2.5 liters of fluid intake daily
- Restrict oral hypotonic fluids (plain water) to <500 mL daily
- Use isotonic drinks like sports drinks or oral rehydration solutions 1
Sodium Replacement:
- Add 0.5-1 teaspoon of salt to meals daily
- For higher outputs, use oral rehydration solution (1L water + 6 tsp glucose + 1 tsp salt + 0.5 tsp sodium bicarbonate) 1
Medication Management:
- Loperamide 2-4 mg taken 30 minutes before meals (maximum 16 mg/day)
- Consider adding codeine phosphate (30-60mg four times daily) if loperamide alone is insufficient 1
Monitoring Parameters
To ensure ileostomy output remains within the target range, monitor:
- Daily stoma output volume
- Body weight (watch for >5% loss)
- Urine output (target ≥800 mL/day with sodium >20 mmol/L)
- Serum electrolytes, urea, creatinine, and magnesium 1
Common Pitfalls to Avoid
Excessive water intake: Plain water increases sodium losses and worsens output. Always balance fluid intake with appropriate sodium replacement 1
Inadequate monitoring: Failure to recognize early signs of dehydration (decreased urine output, increased thirst, dizziness, weight loss) can lead to serious complications 1
Missing underlying causes: High output may be due to intra-abdominal sepsis, partial bowel obstruction, enteritis, or recurrent disease that requires specific treatment 1, 3
Ignoring adaptation period: Recently formed ileostomies produce higher outputs (average 1,200 mL/day) before adaptation occurs within weeks to months 2, 4
In conclusion, while option B (250-500 mL) is closest to the recommended range, the ideal target is slightly higher at 600-800 mL per day for an established ileostomy.