How do you approach the management of a patient with an ileostomy who has recurrent prerenal AKI episodes that improve with IV fluids but worsen with each attempt to transition to oral fluids alone?
How do you approach the management of a patient with an ileostomy who has recurrent prerenal AKI episodes that improve with IV fluids but worsen with each attempt to transition to oral fluids alone?
Join Mednetto vote and see how they answered.
This can be a difficult problem to deal with. In addition to electrolyte losses and volume depletion, these patients can have problems with caloric and micronutrient/vitamin depletion, so close collaboration with a nutritionist and gastroenterologist is important. Assuming the ileostomy can't be reversed or revised, I try to optimize oral hydration with easily absorbed glucose-electrolyte solutions, avoiding excessive ingestion of either hypotonic fluids (e.g., water, tea, coffee) or hypertonic fluids (e.g., soft drinks), which can exacerbate fluid losses. If patients can't tolerate oral hydration solutions, tube feeding may allow the delivery of higher volumes of feedings. In some cases, I have had patients get mediports to allow intermitt...
Join for free or sign in to see the full answer