What is the normal output for an ileostomy?

Normal Ileostomy Output and Management

Normal ileostomy output ranges from 200-2000 mL per day, with high-output defined as greater than 1200 mL per day. 1, 2, 3

Normal Output Parameters

• Volume: 200-2000 mL/day is considered normal
• Consistency: Semi-liquid to paste-like
• Sodium content: Approximately 90 mmol/L in the effluent
• Water content: 89-93% (higher in patients with ileal resection)

Factors Affecting Ileostomy Output

• Anatomical factors:

  • Length of remaining small bowel (especially terminal ileum)
  • Patients with significant ileal resection (>30 cm) typically have higher outputs (average 1202 mL vs 401 mL in those with minimal resection) 4

• Dietary factors:

  • High fluid intake, especially hypotonic fluids
  • High fiber intake
  • Certain foods (caffeine, alcohol, spicy foods)

• Environmental factors:

  • Hot weather increases risk of dehydration due to additional sodium and water loss through sweat 1

Management of High-Output Ileostomy (>1200 mL/day)

Fluid Management

• Restrict oral hypotonic fluids (water, tea, coffee, fruit juices, alcohol) to <500 mL daily 2
• Provide glucose-saline solution with sodium concentration ≥90 mmol/L (1-2L daily) 1, 2
• Modified WHO cholera solution is recommended:
  • Sodium chloride: 60 mmol (3.5 g)
  • Sodium bicarbonate: 30 mmol (2.5 g)
  • Glucose: 110 mmol (20 g)
  • Water: 1 liter 2

Medication Management

• First-line antimotility agent: Loperamide 2-8 mg before meals 2, 5

  • May require higher doses (12-24 mg) due to rapid transit time 1
  • Reduces output by approximately 16.5% (range -5% to 46%) 5

• For persistent high output:

  • Add proton pump inhibitors (e.g., omeprazole 40 mg daily) 2
  • Consider H2 antagonists (e.g., ranitidine 300 mg twice daily) 1, 2
  • Codeine phosphate (30-60 mg four times daily) may be used in combination with loperamide for synergistic effect 2

Dietary Recommendations

• High carbohydrate, normal fat diet 2
• Foods that thicken output: bananas, pasta, rice, white bread, mashed potato 2
• Sodium requirements: 6-10 mmol/kg/day (significantly higher than normal intake of 2-4 mmol/kg/day) 6

Monitoring Parameters

• Daily stoma output volume
• Hydration status
• Electrolytes (sodium, potassium, magnesium)
• Renal function
• Body weight
• Urinary sodium (>20 mmol/L indicates adequate hydration) 2
• In infants/children: spot urine sodium >10 mmol/L indicates adequate sodium intake 6

Common Pitfalls to Avoid

• Encouraging excessive oral hypotonic fluid intake, which paradoxically worsens sodium losses 2
• Failing to correct hypomagnesemia when managing hypokalemia 2
• Inadequate dosing of loperamide - may need higher doses than typically prescribed 1, 5
• Not ruling out underlying causes of high output:
  • Intra-abdominal sepsis
  • Partial bowel obstruction
  • Enteritis (including Clostridium difficile enteritis) 3
  • Recurrent inflammatory disease
  • Abrupt discontinuation of medications 2

By understanding normal ileostomy output parameters and implementing appropriate management strategies, complications such as dehydration, electrolyte disturbances, and renal failure can be prevented.