High Output Ileostomy

WHAT IS HIGH OUTPUT ILEOSTOMY?

A stoma producing greater than 1.5-2L (1500 to 2000mL) of output in a 24-hour period is considered high output.

WHAT DOES HIGH OUTPUT LOOK LIKE?

High output ileostomy typically presents with some of or all these features:
Having to empty your pouch more frequently than normal (typically greater than six times per day)
Watery ileostomy output
Dark yellow or cloudy urine
Increased thirst
Dry skin, dry mucus membranes
Headaches
Muscle aches or cramping
Fatigue
Lightheadedness
Generalized malaise— just not feeling well
Exhibiting these symptoms puts you at risk for severe dehydration and immediate action must be taken to prevent severe or even fatal consequences.

BASIC PREVENTION OF DEHYDRATION

Drink at least 8-12 cups of fluid each day
Drink more when you sweat or have diarrhea
Ingest food/drinks that are high in potassium

Good Sources of Sodium	Good Sources of Potassium
Beverages: bullion, chicken broth, canned or dehydrated soups, tomato juice	Beverages: Skim milk, Gatorade mixed, orange juice, tomato juice. Try mixing sports drinks and juice with water to cut down consumption of added sugar
Protein: Smoked/cured or canned meat, bacon, ham, cheese	Protein: Beef, chicken, scallops, trout, liver, pork, veal, eggs
Vegetables: Canned vegetables, sauerkraut, pickles, olives	Vegetables: Broccoli, tomatoes, potatoes, carrots, yams, lentils, beans, peas, beats
Miscellaneous: Breads and rolls, pretzels, potato chips, crackers, gravy, sauces, condiments, soy sauce	Fruits: Bananas, apricots, avocados, watermelon
	Bread: Pumpernickel, wheat germ
	Miscellaneous: Molasses, cream of tartar, baking powder

Rehydration Therapy Recipes

World Health Organization Reduced Osmolality Oral Rehydration Therapy 1 L (4 ¼ cups) of water ½ teaspoon table salt ¼ teaspoon salt substitute (made with potassium chloride) ½ teaspoon baking soda 2 tablespoons table sugar

Orange Juice Drink 1L (4 ¼ cups) water 1 cup orange juice 8 teaspoons sugar ¼ teaspoon baking soda ½ teaspoon salt Lemonade Drink 4 cups water 2 tablespoons lemonade powder ¾ teaspoon salt

Gatorade Powder drink 1 ½ cups Gatorade or Powerade 2 ½ cups water ¾ teaspoon table salt Grape, Apple, or Cranberry Juice Drink ¾ cup juice of your choice 3 ¼ cups water ¾ teaspoon salt

MEDICATIONS TO PREVENT DEHYDRATION

Many patients can manage high output ileostomy with conservative measures alone. However, you may be advised to take over the counter medications or prescribed medications to prevent high output ileostomy. These medications may include:
Psyllium husk (Metamucil ® )
Loperamide (Imodium ®)
Diphenoxylate and atropine (Lomotil ®)
Cholestyramine
Proton Pump Inhibitor (Protonix ®)
Outpatient IV (intravenous) fluids though IV clinic or home infusion

WHAT DO I DO IF I EXPERIENCE HIGH OUTPUT ILEOSTOMY?

Ensure that you are drinking enough rehydrating fluids, eat foods that are high in potassium, begin daily fiber supplementation with psyllium husk (Metamucil ®), wheat dextrin (Benefiber ®) or fiber tablet (FiberCon ®)
Contact your Wound Ostomy Care Nurse or contact our office immediately at (208) 302-2400 for urgent intervention.