A high-output enterocutaneous fistula may, if from the proximal small bowel, behave in the same way and its fluid management will be the same as for an HOS
- AIM: stoma output approximately 1000ml and able to maintain own hydration / fluid and electrolyte balance with PO intake
9 However, the output decreases over the following days and weeks, a process termed “adaptation
Loperamide and codeine phosphate reduce intestinal motility and thus decrease water and sodium output from an ileostomy by approximately 20–30%
Colostomy >700 mL/day Loperamide 2 mg q6h Loperamide 4 mg q6h
In the meta-analysis, there was no difference in stoma output between controls and somatostatin analogues ( g − 1
High output is a common complication after stoma formation
Hospira UK Ltd
The following report describes three patients with end ileostomy
Pharmacological Therapy
Commence loperamide (high dose) before food
High Output Defined As Table 3 shows, there can be many causes of high output, which in turn may lead to dehydration and kidney injury
Loperamide 2 mg q6h Loperamide 4 mg q6h Diphenoxylate/atropine 5 mg q6h Diphenoxylate/atropine 10 mg q6h Ileostomy >1000 mL/day Loperamide 2 mg q6h Loperamide 4 mg q6h + Diphenoxylate/atropine 5 mg q6h Diphenoxylate/atropine 10 mg q6h Tincture of opium 0
Methods MEDLINE, Cochrane Library, BNI, CINAHL, EMBASE
tea, coffee, water As Table 3 shows, there can be many causes of high output, which in turn may lead to dehydration and kidney injury
A multidisciplinary approach to management ensures the best possible outcome and quality of life for patients who
0 L / 24 hours
depending on baseline volume of stoma output, a starting dose of 2mg - 10mg four times a day of loperamide may be prescribed and titrated according to individual response
Loperamide tablets * Used to slow the movements of the bowel to allow fluid and nutrition more time to be absorbed
Although the management of high output is described in the literature, there is a lack of consensus on definitions and treatment
The capsule can be opened and the powder contents dispersed in 10ml of water for administration
Loperamide [doses above 16mg daily are unlicensed] Starting dose 4mg tds titrate up to maximum of 16mg QDS
Perform an ECG in all patients with a high output stoma/fistula before starting high dose loperamide (more than 4 mg four times a day) and the QT interval should be measured and documented
Most high-output stomas should reduce their output over time
Level 2b: