Abstract
Sodium and potassium in the ileostomy output and urine were determined in 28 patients with ulcerative colitis on a free diet and in eight patients on a defined constant diet, before and after conversion from a conventional ileostomy (CI) to a continent reservoir ileostomy (RI). Feces and urine were collected both in the hospital and at home. Patients with CI on free diet had a median intestinal loss of 62 mmol sodium and those with RI 74 mmol/24 h collected in the hospital (p<0.05). The figures for at home was 79 and 81 mmol/24 respectively, and were larger than in the hospital (p<0.01). Sodium loss in the urine (U−Na) and the intake of sodium did not change significantly after conversion. Patients with a low U−Na before conversion also had a low U−Na after, in a few almost nil, implying a need for increased intake of sodium. Patients with a CI and low urinary output of sodium should be carefully studied with respect to their sodium balance before accepting them for conversion to RI. The ileostomy output of potassium increased after conversion (4.3 vs. 6.8 mmol/24 h; p<0.01) in the hospital (5.3 vs 7.1 mmol/24 h; p<0.01) at home. Patients on a defined constant diet before and after conversion did not show any significant differences in absorption of sodium, potassium, magnesium or calcium after conversion, but did show a reduced dry weight of the ileostomy output, indicating an increased degradation of intestinal contents in RI patients. In conclusion, in the majority of patients, conversion from a conventional to a reservoir ileostomy does not involve any change of intestinal electrolyte losses with consequence in the hemeostatis.
Résumé
Le sodium et le potassium dans le liquide d'iléostomie et les urines ont été calculé chez 28 malades présentant une colite ulcéreuse avec un régime libre et chez 8 malades avec un régime constant et défini, avant et après conversion d'une iléostomie conventionnelle (IC) en une iléostomie continente avec réservoir (IR). Les matières et les urines étaient recueillies à la fois à l'hôpital et à domicile. Les malades avec IC et un régime libre avaient une perte moyenn2e intestinale de 62 mmol de sodium et ceux avec IR de 74 mmol/24h recueillie à l'hôpital (P<0.05). Les chiffres à domicile étaient de 79 et de 81 mmol/24h respectivement et étalent plus grand qu'à l'hôpital (P<0.01). La perte de sodium dans les urines (U-NA) et l'apport de sodium ne variaient pas significativement après conversion. Les malades avec un U-NA bas avant conversion avaient aussi un U-NA bas après. Nul ne nécessitant toutefois l'apport de sodium. Les patients avec un IC et une excrétion urinaire basse de sodium doivent être étudiés minutieusement quant à leur balance respective de sodium avant d'entreprendre une conversion en IR. L'excrétion de potassium du liquide d'iléostomie augmentait après conversion (4.3 vs 6.8 mmol/24 h; P<0.01) à l'hôpital (5.3 vs 7.1 mmol/24 h; P<0.01) à domicile. Les patients qui avaient un régime défini constant avant et après conversion ne montraient aucune différence significative dans l'absorption du sodium, du potassium, du magnésium ou du calcium après conversion mais montraient une réduction du poids sec de l'excrétion d'iléostomie, indiquant une dégradation augmentée du contenu intestinal chez les patients avec IR. En conclusion dans la majorité des patients la conversion d'une iléostomie conventionnelle en une iléostomie avec réservoir ne comporte aucune modification des pertes électrolytiques intestinales entraînant des conséquences de l'homéostase.
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Brevinge, H., Bosaeus, I., Philipson, B.M. et al. Sodium and potassium excretion before and after conversion from conventional to reservoir ileostomy. Int J Colorect Dis 7, 148–154 (1992). https://doi.org/10.1007/BF00360356
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DOI: https://doi.org/10.1007/BF00360356