What is the recommended amount of ileostomy output to maintain?

Recommended Ileostomy Output Volume

The recommended amount of ileostomy output to maintain is 500-700 mL per day, with high output being defined as >1000 mL/day, which requires intervention to prevent dehydration and electrolyte imbalances. 1

Normal vs. High Output Ileostomy

• Normal output: 500-700 mL/day
• High output: 1000-2000 mL/day (requires monitoring and intervention)
• Very high output: >2000 mL/day (significant risk for dehydration, electrolyte depletion, and malnutrition) 1

Management of Ileostomy Output

Fluid and Electrolyte Management

• Maintain 2-2.5 liters of fluid intake daily
• Add 0.5-1 teaspoon of salt to meals daily
• Target urine output ≥800 mL/day with sodium >20 mmol/L 1
• For high output (>1000 mL/day):
  • Restrict oral hypotonic fluids to <500 mL daily
  • Provide glucose-saline solution with sodium concentration ≥90 mmol/L (1-2L daily) 1

Medication Management for High Output

1. Anti-motility medications:

   • Loperamide 2-8 mg before meals (first-line)
   • Can increase to high doses (12-24 mg at a time) for patients with short bowel 2, 1
   • Codeine phosphate 30-60 mg four times daily if loperamide alone is insufficient 1

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

   • Add drugs that reduce gastric acid secretion (H2 antagonists or proton pump inhibitors)
   • Consider omeprazole 40 mg daily 2, 1
   • Octreotide may be considered if unable to absorb oral drugs 1

Monitoring and Complications

Key Parameters to Monitor

• Daily stoma output volume
• Body weight
• Urine output
• Serum electrolytes, urea, creatinine, and magnesium 1

Warning Signs of Dehydration

• Increased thirst
• Dizziness
• Weight loss >5%
• Decreased urine output (<800 mL/day) 1

Important Considerations

• High-output ileostomy (>1200 mL/day) can quickly result in dehydration and may cause acute renal failure if not properly managed 3
• Plain water increases sodium losses and worsens output; always balance fluid intake with appropriate sodium replacement 1
• Patients who have undergone significant ileal resection typically have higher daily output volumes (average 1202 mL vs. 401 mL in those with minimal resection) 4
• Early high output from an ileostomy is common, occurring in approximately 16% of ileostomies/jejunostomies 5

Common Pitfalls to Avoid

1. Encouraging excessive water intake without sodium replacement
2. Failing to recognize underlying causes of high output (intra-abdominal sepsis, bowel obstruction, enteritis)
3. Inadequate monitoring of electrolyte imbalances
4. Delayed intervention for persistent high output
5. Not adjusting medication dosages appropriately (higher doses often needed due to rapid transit time) 2, 1

The correct answer is A. 500-700 mL.