By: Kristin Knipp, LPN

With up to 40% of all hospital readmissions after ostomy surgery being due to dehydration [1], it’s clear that many new ostomates are not being armed with the tools they need to mitigate this often-preventable risk that accompanies living with a stoma.

As a nurse, and ostomate of twenty-eight years, I have become attuned to the subtle symptoms that my body uses to alert me to fluid and electrolyte depletion. However, it wasn’t always that way. I had my ostomy surgery in 1991, at the age of fifteen. I had just made the JV cheerleading squad for the following year and was slated to attend an overnight cheer camp exactly six weeks after my ileostomy formation. Surgery went well, and I received medical clearance to attend just days before I set out for four days of physical training and spirit-building.


The weather was hot and humid at camp, and I was outside in the sun all day and in a room without air conditioning all night. I was trying to stay on top of my fluid intake, but I didn’t have a plan in place. It started with being extra thirsty and feeling a little dizzy throughout the day. By the third evening of camp, it had progressed to a pounding headache, and my muscles were cramping during our evening walk back to the dorms. On the bus ride home the following day, my heart was racing, and I had terrible nausea. When my mom picked me up, I collapsed into the car, and through my tears, told her to take me to the emergency room. I was admitted to the hospital that evening and received several bags of IV fluids and electrolyte boluses to bring me back to safe levels.


Thankfully, that episode didn’t have a lasting impact of my overall recovery from surgery, but it has given me insight into how as a nurse I can better educate my patients about the seriousness of dehydration.


PROVIDING GUIDELINES
Providing patients with a numerical guideline to follow in both oral intake and stoma output takes the guess work out of the equation for new patients. Average output for the ileostomy patient ranges from 500 to 1300 mL a day. During the early postoperative period and episodes of gastroenteritis, daily output can be 1800 mL or even higher [2]. If a patient is reluctant to measure their output in a separate container at home, suggest an 11 Health Smart Bag system which monitors patients output and track it in real-time to their phone or tablet. If using a standard ostomy pouch, teach them how many milliliters their pouch holds at half capacity. They can then quickly estimate daily output by multiplying how many times they have emptied their pouch by the volume that the pouch holds when half full.


New ostomates should be taught to consume at least 500-750 ml in additional fluids daily over their baseline, and to take in more during times of heavy ostomy output or increased sweating. If your patient has not been given a target number by their care team, 11 Health offers a Hydration component within the Alfred SmartCare app where patients can calculate a daily hydration goal, as well as track oral intake.


SIGNS AND SYMPTOMS OF DEHYDRATION

Fluid depletion often starts with just a subtle increase in thirst. Tell patients if they’re feeling thirsty, they’re likely experiencing a fluid deficit and should make extra effort to increase fluid intake over the next twenty-four hours. Other symptoms of dehydration are less obvious as well such as feeling lethargic and headaches. More prominent signs of dehydration include dizziness upon standing, dark/concentrated urine and decreased urine output, abdominal cramping, muscle cramping in extremities, and heart palpitations. [3,4] If patients are unsure if the signs they are experiencing could be leading to dehydration, 11 Health also offers a Hydration Risk Assessment within their SmartCare app. The app uses a fingertip and short questionnaire to determine if a patient is exhibiting early signs of dehydration so that they can adjust intake accordingly or seek medical attention if needed.
Education is essential in health promotion and disease prevention. The few minutes you spend discussing the importance of hydration with your ostomy patient may be the key to preventing a hospital admission or trip to the emergency department. That’s a huge win, and 11 Health is here to cheer you on!

  1. Fish DR, Mancuso CA, Garcia-Aguilar JE, et al. Readmission After Ileostomy Creation: Retrospective Review of a Common and Significant Event. Ann Surg. 2017;265(2):379–387. doi:10.1097/SLA.0000000000001683
  2. McCann E. Routine assessment of the patient with an ostomy. In: Wound, Ostomy, and Continence Nursing Secrets, Milne C, Corbett I, Dubuc D (Eds), Hanley and Belfus, Philadelphia 2003.
  3. Erwin-Toth P, Doughty D. Principles and procedures of stomal management. In: Ostomies and Continent Diversions: Nursing Management, Hampton, B, Bryant, R (Eds), Mosby, St. Louis 1992. p.29.
  4. Carmel J, Goldberg M. Preoperative and postoperative management. In: Fecal and Urinary Diversions: Management Principles, Colwell, J, Goldberg, M, Carmel, J (Eds), Mosby, St. Louis 2004. p.207.