Recommended Ileostomy Output Levels
The recommended ileostomy output to be maintained is between 500-700 mL per day, which corresponds to answer choice A. 1
Understanding Normal vs. High Output Ileostomy
According to the European Society of Coloproctology guidelines, ileostomy output should be carefully monitored and managed:
- Normal output: 500-700 mL per day for an established ileostomy
- High output: Defined as 1000-2000 mL/24h 1
- Very high output: >2000 mL/24h (significantly increases risk of dehydration, electrolyte depletion, and malnutrition) 1
It's important to note that recently formed ileostomies may initially produce higher volumes (around 1,200 mL per day) of watery stool, while established ileostomies typically settle to produce between 600-800 mL per day 2.
Management of Ileostomy Output
Fluid and Electrolyte Balance
- Maintain 2-2.5 liters of fluid intake daily 1
- Add 0.5-1 teaspoon of salt to meals daily 1
- Monitor weight, urine output (target ≥800 mL/day), and serum electrolytes regularly 1
Key Interventions for High Output
If output exceeds 1000 mL/day:
- Restrict oral hypotonic fluids to <500 mL daily (Grade B evidence) 1
- Provide glucose-saline solution with sodium concentration ≥90 mmol/L 1
- Consider anti-motility medications such as loperamide 2-8 mg before meals 1
- Add codeine phosphate if loperamide alone is insufficient 1
Clinical Implications of Output Volumes
- <500 mL/day: Generally indicates good adaptation and management
- 500-700 mL/day: Target range for established ileostomies 1
- >1000 mL/day: Requires intervention to prevent dehydration 1, 3
- >1200 mL/day: Defined as high-output ileostomy, requiring prompt management 3
Monitoring Recommendations
For all ileostomy patients, but especially those with outputs approaching or exceeding 1000 mL/day:
- Monitor daily stoma output volume
- Track body weight (watch for >5% weight loss)
- Measure urine output (target ≥800 mL/day with sodium >20 mmol/L)
- Check serum electrolytes, urea, creatinine, and magnesium regularly 1
Common Pitfalls to Avoid
- Encouraging excessive water intake without sodium replacement (worsens output) 1
- Failing to recognize early signs of dehydration (decreased urine output, increased thirst, dizziness)
- Overlooking underlying causes of high output (intra-abdominal sepsis, partial bowel obstruction, enteritis, medication changes) 1
- Neglecting to monitor for electrolyte imbalances, particularly hyponatremia, hypokalemia, and hypomagnesemia 1
The evidence clearly supports maintaining ileostomy output between 500-700 mL per day as the optimal target for established ileostomies, with prompt intervention required if output exceeds 1000 mL/day.