Citation: International Journal of Surgery. 2013, 11(8), 621
Author: Appleton N.D.; Corris A.; Edwards C.; Kenyon A.; Walsh C.J.
Abstract: Aim: Fluid and electrolyte management for patients with high output stomas/enterocutaneous fistulae is challenging. Historically, their care required repeated admissions to avoid ongoing complications eg, acute renal failure.We report our experience of outpatient management of such patients led by a nutrition support team. Method: A retrospective analysis of a prospectively maintained database was performed.
All patients met their nutrition needs enterally. Patients attend a ward based clinic with facilities for monitoring (weight, fluid balance, diet, PICC line care, bloods, urinary sodium and medication review) and IV hydration and/or magnesium/potassium supplementation. Individual cases are discussed at a weekly nutrition support meeting. Results: Between September 2009 - September 2012, 83 patients attended (male:female
43:40, median age 66, range 18-92). 73 had high output stomas, 11 had enterocutaneous fistulas. Total clinic days attended was 1239 (median 9 range 1-109 days). On 224 visits, IV fluids were administered, of which 95 were given IV magnesium and three, IV potassium. Eleven required admission (admission rate of 1%). Other outcomes were either optimisation for surgery, discharge without surgery or long term monitoring
without inpatient stay. Conclusion: Patients with complex fluid balance and electrolyte needs can be managed successfully in the outpatient setting.
