Recommended Daily Ileostomy Output
The recommended daily ileostomy output should be maintained between 500-700 mL per day, with high output being defined as >1000 mL/day requiring intervention. 1
Normal vs. High Output Ileostomy
- Normal output: 500-700 mL/day 1
- High output: >1000 mL/day 1
- Very high output: >1200 mL/day (risk of dehydration and acute renal failure) 2
- Secretory output: >3000 mL/day (requires specific interventions) 3
An established ileostomy typically produces between 600-800 mL of output per day 4, while recently formed ileostomies may produce up to 1,200 mL of watery stool daily 4.
Monitoring Ileostomy Output
Proper monitoring of ileostomy output is essential to prevent complications:
- Daily stoma output volume measurement
- Body weight monitoring (weight loss >5% indicates dehydration)
- Urine output (target ≥800 mL/day)
- Serum electrolytes, particularly sodium, potassium, and magnesium
- Signs of dehydration (increased thirst, dizziness, lightheadedness) 1
Management of High Output Ileostomy
When output exceeds 1000 mL/day, interventions should include:
Fluid Management
- Restrict oral hypotonic fluids to <500 mL daily 3, 1
- Provide glucose-saline solution with sodium concentration ≥90 mmol/L (1-2L daily) 1
- Maintain total fluid intake of 2-2.5 liters daily, adjusted for weather and activity 1
Medication Options
- First-line: Loperamide 2-8 mg before meals (can be increased to 12-24 mg for severe cases) 3, 1
- Second-line: Add codeine phosphate 30-60 mg four times daily if loperamide alone is insufficient 1
- For secretory output (>3 L/24 hours): Add H2 antagonists or proton pump inhibitors 3
Dietary Modifications
- Consume foods that thicken output: bananas, pasta, rice, white bread, mashed potato
- Consider small, frequent, nutrient-dense meals
- Add 0.5-1 teaspoon of salt to meals daily 1
- Separate solids and liquids (no drinks 30 minutes before or after food) 3
Risk Factors for High Output Ileostomy
Several factors can predispose patients to high output:
- Significant terminal ileum resection (>30 cm) 5
- Crohn's disease 6
- Older age 6
- Right-sided colectomy or small bowel resection 6
- Underlying infections (e.g., Clostridium difficile enteritis) 2
Common Pitfalls to Avoid
- Encouraging excessive water intake without sodium replacement
- Failing to recognize underlying causes of high output
- Inadequate monitoring of electrolyte imbalances
- Delayed intervention for persistent high output
- Not adjusting medication dosages appropriately 1
In conclusion, maintaining ileostomy output between 500-700 mL/day is optimal for patient health and prevention of complications. When output exceeds this range, prompt intervention with fluid restriction, electrolyte replacement, and anti-motility medications is essential to prevent dehydration and electrolyte disturbances.