Changes in Serum Electrolytes Following Permanent or Temporary Ileostomy

Background: Patients with ileostomies are well known to be susceptible to extracellular fluid volume depletion as a result of fluid and solute losses that are greater than intake. However, electrolyte disorders accompanying these episodes of volume depletion are not well delineated. Objective: To find out serum electrolytes changes observed in patients undergone permanent or temporary ileostomy. Method: This prospective observational study was carried out in the Department of Colorectal Surgery, BSMMU, Dhaka, from January 2018 to December 2018. Fifty patients underwent permanent or temporary ileostomy and postoperatively treated with intravenous fluid and electrolytes at least up to 3 rd POD along with gradual resumption of oral intake or ileostomy feeding and managed at least for 5 days were included in this study. Electrolyte was measured preoperatively and 3 rd and 5 th POD and observed the changes. Result: Males were predominant than females (1.17:1). Most of the patients were in age group 31 – 40 years. Mean age was 42.4±12.5 years. Serum sodium (Na) and serum potassium (K) were reduced at POD 3 and at POD 5 compared to pre-operative level. Serum sodium concentration was 136.6±3.75 mmol/L pre operatively and reduced to 135.1 ±2.98 mmol/L at 3 rd POD and 134.8±3.04 mmol/L at 5 th POD. Similarly, serum potassium concentration was 4.0±0.49 mmol/L pre operatively and reduced to 3.8±0.70 mmol/L at 3 rd POD and 3.8±0.50 mmol/L at 5 th POD. Both serum Na and serum K level reduced significantly in POD 3 and in POD 5 in comparison to pre-operative values ( p <0.05). Regarding serum Cl and serum HCO 3 level no statistically significant difference were observed ( p >0.05). Conclusion: Serum sodium and potassium concentration reduced statistically significantly after permanent ileostomy.

maintain electrolyte and acid-base equilibrium. [3][4][5][6] However, the new equilibrium is fragile, particularly in patients with daily ileostomy drainage of 1 L or greater. These patients often have Crohn disease and may have lost part of the ileum to disease. 4 Despite the appearance of normality, measurements in apparently healthy patients with ileostomies show a 7% to 11% decrease in total body sodium and water, indicating the presence of stable modest extracellular fluid volume depletion. 6 Not surprisingly, symptomatic volume depletion is not uncommon, occurring when either ileostomy drainage abruptly increases or dietary intake is disrupted or in the presence of excessive sweating. 5,6 In newborn infants with ileostomies, both metabolic acidosis and alkalosis have been reported to occur. 7,8

Materials and Methods
This prospective observational study was done in the department of Colorectal Surgery, BSMMU, Dhaka over a period of one year during January-December 2018. Fifty patients of all age groups and both sexes who underwent ileostomy and postoperatively treated with intravenous fluid and electrolytes at least up to 3 rd POD along with gradual resumption of oral intake or ileostomy feeding and managed at least for 5 days were included in this study. Patients with known co-morbidities such as renal and respiratory failure, end stage liver disease or patient who did not survive within respective study period (5 days) or patients having uncontrolled diabetes were excluded from the study. After taking proper consent and counseling, subjects were evaluated clinically by amount of stoma output, urine output, routine and special investigation (serum electrolytes: sodium, potassium etc.). Electrolytes were measured preoperatively and 3 rd and 5 th POD and observed the changes and these data were statistically evaluated and management protocol of this patients. Paired 't' test was used to infer the difference in means. For significance, p-value <0.05 was considered as significant.

Results
A total number of 50 patients with ileostomy were recruited in this study. Patients' demography and baseline data were recorded using semi-structured questionnaire (table I).  Changes of Na, K, CL and HCO 3 levels at POD 3 and POD 5 compared to pre-operative level were also recorded (table III).

Discussion
Maintenance of normal fluid-electrolyte balance is needed for maintenance of homeostasis of the body. In electrolyte imbalance serum electrolytes are routinely measured. For all practical purposes, serum electrolyte levels along with finding of clinical status were used for clinical management of patient. Usually an excess loss of fluid and/ or electrolytes occurs through gastrointestinal tract, respiration, skin, kidney and other abnormal process of elimination like vomiting, fistulas, and surgically created ostomies like ileostomy and colostomy.
The aim of current study was to find out serum electrolytes changes observed in patients undergone permanent or temporary ileostomy. Fifty patients who underwent ileostomy and postoperatively treated with intravenous fluid and electrolytes were included in the current study. In this study, maximum number of patients were in age group 31 -40 years.

Conclusion
Based on the study findings, it may be concluded that the serum sodium and serum potassium concentration reduced significantly in POD3 and in POD5 in comparison to pre-operative baseline values. In all patients who undergo ileal resection along with ileostomy should be closely monitored for electrolyte derangement from the 3rd post-operative day onwards so that an optimal electrolytes balance can be maintained.