Protocol for the detection and nutritional management of high-output stomas

Nutrition Journal

Pilar Utrilla Navarro²  Norberto Gándara Adán¹  Robin Rivera⁴  Jimena Abilés³  Cristobal López-Rodríguez³  Jose J Arenas Villafranca³ 

[1] General Surgery Service, Costa del Sol Hospital, Marbella (Málaga), Spain;Pharmacology Department, University of Granada, Granada, Spain;Pharmacy and Nutrition Service, A7, km. 187, Hospital Costa del Sol, Marbella (Málaga) 29603, Spain;Gastroenterology Service, Costa del Sol Hospital, Marbella (Málaga), Spain

关键词: Protocol;    Readmission;    Ileostomy;    Hypomagnesaemia;    High-output stomas;   

Others  :  1222127
DOI  :  10.1186/s12937-015-0034-z

 received in 2015-01-17, accepted in 2015-05-01,  发布年份 2015

【 摘 要 】

Introduction

An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management.

Materials and methods

This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery.

Results

Early HOS was observed in 7 (16 %) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16 %) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100 % effectiveness. 50 % of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33 % of the late HOS patients.

Conclusion

The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.

【 授权许可】

   
2015 Arenas Villafranca et al.

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