DEHYDRATION AND THE ILEOSTOMY

By Terry Gallagher, UK (Edited & Excerpted): UOAA Update March 2015

In someone with a working colon, the colon is responsible for absorbing most of the water we drink and that is contained in our food. In addition, electrolytes such as sodium and potassium, essential to maintaining good health, are absorbed there. Removal or disconnection of the colon immediately causes the first problem because of the removal of the ileo-valve. This valve is between the ileum (or small intestine) and the colon where the appendix is attached. Its purpose is to hold back the food in the ileum to enable it to be absorbed better.
As an ileostomate, when we lost this valve, food and water pass through our digestive system faster, so less is absorbed, often accounting for weight loss when a person first recovers from the surgery. The ileum does absorb more water to compensate, but still absorbs much less than the colon did. Waste from the ileum normally has about 30% of the water remaining, while waste from a colon has about 10% remaining – quite a difference. In addition, the ileostomate loses ten times as much sodium and potassium as someone with a colon.
Because of all this, anything which upsets the balance in our bodies has a much faster effect, as well as happening much quicker than in a person with a working colon. A typical example is gastroenteritis. A person with a working colon with the same degree of infection may be sick and have diarrhea for a couple of days, whereas someone with an ileostomy may well end up in the hospital as an emergency.  This may apply to other problems with upset the digestive system’s balance as well as gastroenteritis. When these occur, a person with a working colon experiences nausea, vomiting, fever, abdominal cramps, sometimes bloody diarrhea and signs of dehydration (including the veins on the back of the hands and elsewhere becoming invisible).
Those of you with an ileostomy may fill up very rapidly with fluid. On emptying, the pouch can refill in minutes. You may feel nauseous and develop abdominal discomfort. You may rapidly begin to experience the symptoms of dehydration, which dry mouth, decreased or virtually non-existent urine output, heart irregularities and dry skin. In many cases, you can see urine out has ceased. This is a medical emergency!
If hospitalized for dehydration, the ileostomate may expect iv solutions to be given. The fluid given will be saline, potassium, or potassium and glucose to replace those essential electrolytes lost as mentioned earlier. Expect an EKG (to check for heart problems), bloods to be taken and stool and urine samples (to check for infection), and check and abdominal x-rays.  Dehydration treatment can also lead to kidney damage, which may be permanent, requiring lifelong dialysis or a transplant.
If you become ill with diarrhea, vomiting and fever that persist and you find yourself with a pouch which is filling and refilling with fluid and start to develop a dry mouth with abdominal pains, seek emergency treatment immediately. Normal people may sneer that we’re making a lot of fuss for a simple “tummy ache”, but we’re not! It can be much more serious for us than for people with working colon.

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