Dehydration

Replies
14
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518
Mar O

New to this having a problem with Dehydration and taking in enough Calories any suggestions ? 

AlexT

Eat and drink more. Lots of small meals and drink a variety of fluids. You gotta force yourself sometimes. Maybe take some medication to slow your output but I don’t like to recommend anyone taking medication if they don’t have to. 

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w30bob

Hi M,

  You need to tell us why you got your ostomy and what plumbing you have left.  How you solve your problem depends on what you still have and if it's functioning properly.  

;O)

xnine

Try OstoAI for more info and old posts, 'hydration'.

Morning glory

Welcome  to the site. I remember  having to force myself  to eat and drink more. One suggestion  is try to add boost or ensure a couple of times a day. This is in addition  to your meals not as a replacement.

 
Living with Your Ostomy | Hollister
Justbreathe

Dehydration with ileostomy is a problem - for me trying to hydrate enough (copious amount of drinking water) merely lowered my sodium levels and did not help.  What I have learned so far - from this site and docs is fiber is necessary- I am talking powder type fiber.  I put 2 teaspoons in a smoothie each morning - it thickens output which I believe has helped with my dehydration problem. jb

w30bob

Hi M,

  Rereading my reply I didn't mean to come off as terse, it's just that this subject has been covered so often on here and there is no one answer that covers everyone.  The reason why your ostomy is important because the type and amount of bowel you have left will determine how you have to hydrate. Search on here for 'hydration', 'hydrating', 'ORS', 'oral rehydration', etc and you should find more info than you want. 

  In a nutshell your colon does the majority of your water absorption.  Your small bowel can do a little bit towards the end of its run, but it's primary job is nutrient absorption and bile re-absorption for recycling.  If your colon is no longer in the game there will be no way for your small bowel to absorb water and it will just end up in your bag (minus the small amount the end of your small bowel may be able to absorb).  So by drinking water to stay hydrated all you're really doing is flushing the nutrients out of your small bowel before the bowel walls can absorb them and diluting your bile in the small bowel so your nutrients can't be broken down small enough for the bowel walls to absorb and stressing out your gallbladder.  A double whammy if you will.  If you're missing your terminal ileum (the part at the very end before your ileocecal valve and where your colon starts) as well as your colon then your bile can't be re-absorbed, which not only fills your bag with bile (and all the water you can't absorb), but works the crap out of your liver to make more bile that you just flushed away.  Ileostomates should always monitor their liver function for this reason, because if your liver goes tits-up it's game over.  If you're a colostomate things are much better in terms of hydration.  Having even a third of your colon intact can provide the necessary surface area to reabsorb a lot of water, unless what's left is diseased.  

  So you can see that depending on what plumbing you have left, and the condition it's in, will make or break hydration.......at least by the normal means.  But all is not lost if you're an ileostomate, even if your terminal ileum is long gone.  You just have to change how you hydrate and 'trick' the small bowel into absorbing water along with what it normally absorbs.  That's a topic unto itself and I gotta rock.........so if that's you just search the forum for the words I wrote above.  If you come up empty just shout.  I've written on this subject just shy of a million times, so I doubt the other members would mind if I did it once more.  Just can't do it now.  

regards,

bob

Justbreathe
Reply to w30bob

w30bob….GAWD I’VE MISSED YOU!!!  Glad you are back and thx for this explanation - makes more sense to me than any doc visits I’ve had recently.  I just went thru a bunch of tests for kidneys- apparently my numbers are too high blah, blah blah and it appears I have stage 3b chronic kidney disease.  Is this serious - I’m not sure…There’s a doc for everything and the right hand doesn’t know what the left hand is doing and the peeps of the world, insurance companies, and Medicare are just forking over the $’s……for all these tests leading to more tests and more docs and more questions that go unanswered.  

I do not know what parts I have left after my emergency ileostomy surgery and resulting stoma.  This is my own fault.  In defense of my surgeon who was planning on my reversal.   I was on vacay and had to return home to a new surgeon.  Circumstances (heart attack etc.) halted me in my tracks in a follow up reversal plan for well over 6 months.   Now, because I feel well both mentally and physically take no medications and have distrust issues with the medical profession along with my age factor I choose happy and stumble along to resolve the small issues that pop up from time to time.  Basically I have found, at least for myself, no doctor appointments makes for happy days, weeks, months and who knows possibly years.  Pain will be the only thing that will interrupt my life in Denialville.  Thanks again for the info and having to repeat useful information is kinda like fishing if you are a “catch and releaser” when you catch one and throw it back it may have learned an important message and you feel good about it.  jb

Kas

I have a colostomy and short gut syndrome - always dehydrated.  My team has me drinking liquid IV 45-64 ounces a day in sips and limiting other fluids. Gatorade has too much sugar which pulls water out and can cause liquid stools, fake sugars can do the same. No caffeine, no juice (unless cut with water).  Imodium 4 times a day.  I still have to go to the infusion 2-3 times a week for iv fluids.

Why your dehydrating is important.  Liquid stool?  Short gut?  Diet?  Not drinking enough?

w30bob
Reply to Kas

Hi Kas,

  I'm short-gutted too, but try to never be dehydrated.  I started out on TPN and IV hydration, but weened off that in a year and never looked back.  The home infusion company you use can make all the difference.  If you still use one let me know and I'll turn you on to the best company out there.  And I mean hands down the best.  But I assume you're off TPN and eating normally......well, normally for us.  And that you've read Carol Reese Parrish's book on Management of Short Bowel Syndrome, right?  If not you can find free downloads online easily or get the actual book for free here just by signing up (also free);

https://www.shortbowelsyndrome.com/sign-up

  I've found all her advice to be correct (except what she says about bowel adaptation) but since everyone is different some of what to do may need some tweaking.  I just can't do the 'small sips all day" stuff and after working outside or working out I need to DRINK, not sip.  I've learned to temper my thirst cravings, but they're always there just waiting for me to be weak and succumb.  I've found the best way to successfully hydrate is after my bowels are mostly clear of food and nutrients.  It's a simple surface area issue.  If there's food jammed into all the villi of the intestinal wall, there's no way any liquid can get past that to be absorbed.  I'm talking ORS here, as water can never be absorbed by itself).  I've learned to stay up very late, as I need more time to absorb nutrients than a normal person, so I rehydrate every night before I go to bed.  I start drinking a liter of ORS around 2:30am do it within 30 minutes.  If I'm feeling sporty or had a real rough day in the heat I may go for a full liter.  I have no output after that, as it all gets absorbed, and usually hit the hay around 4:30am and bounce out of bed again around 8:00am.  None of this happened overnight and I had to train myself to stop eating around midnight (so my bowels were clear by 2:30am), as well as the staying up late part.  On very strenuous days I might take a power nap for an hour around midnight, but other than that there's no issues.  My point is you have to not fight your body, but adapt to it and how it now functions.  You'll need to figure that out with experimentation, so take good notes.  But you can get there.  If you need more info or want to chat just PM me.  But make sure you read Carrol's book.....it really is a game changer for folks like us.  I've put the chapters of the book on here in the past as well as the link above, but sometimes using the search is a futile waste of time.  Sorry Admin, but it just is. 

Reach out if you need more help!  

;O)

 

judiprescott17

due to my chronic dehydration(high ileo) I am having some kidney pain, and the doc has ordered a kidney ultra sound and prescribed IV hydration 2X a month. I haven't found a place except the ER to do this locally.

One participant said what I feel about trying to drink enough and not flush out your electrolytes. Even drinking an equivalent of Pedialyte, I am still not well hydrated. Doc even spoke to me about putting in some sort of port for the IV's if I begin to need it more than twice a month.

Kas
Reply to w30bob

Hi and thank you for the information.  I just joined and ordered the book.  I’ve been off of TPN since October but still have the port in my chest for probably another year or two because my colostomy was due to rectal cancer  and they don’t want to remove the port until they’re sure it’s ok to do so.  

w30bob
Reply to judiprescott17

Hi jp,

  I'm guessing you don't have a central line (PICC line) installed?  If you did your insurance should pay for a home infusion company to provide IV fluids for you to do yourself at home.  The port is one of those mixed blessing things.  If you have a central line in your arm or leg then losing that and switching to a port can make things a lot easier, as you won't have the line ends dangling and it can't be pulled out.  But infection is always looming, and ports provide an even shorter path to your heart if an infection does develop, so you really have to stay on top of your port care and not hesitate to hit the ER if you suspect something is wrong.   Some do really well with a port, some not so much.  A lot depends on the amount of body fat you have, the thickness of your skin where the port is installed and the skill of the installer.  Most of the time they install it up near your collar bone, and if your skin is thin it will protrude a bit and can be chronically sore in that area.  They're a better long term option than the PICC line, or so I'm told, but there's no free lunch, as usual.  I had a PICC for a year and didn't really have any major issues with it.  My Mom had a port and she hated it.  Most Docs will tell you it's the other way around, so research it a bit before you decide. 

Your best bet is to properly hydrate and give your kidneys a break.  Hydration drinks like Pedialyte are not the optimal formulation for ostomates.  They're better than hyper and hypotonic drinks, but they tend to miss the mark because they're formulated for kids, so they have the correct amount of glucose (sugar) but only half as much sodium (salt) to make it paletable for the little ones.  You might want to read the book I recommended to jp above, as you'll find that once you understand how to trick the small bowel into absorbing water when it's absorbing sodium and glucose your hydration problem will go away.  Even better, as time goes on and your bowels adapt, you can train them to absorb more diluted concentrations of ORS and ultimately hydrate with pure water.  It's a lot of work and not for those who aren't playing the long game, as it's taken me almost 8 years to do, but it can be done.  I can even hydrate with milk, but I have to really be on top of my game and paying very close attention to what and when I eat and what my bile situation is.  But the point is you can get there from here if you know how.  Sadly most Docs and even Dieticians don't.  But as more folks suffer the fate of our poisoned food supply, the number of ostomates will continue to skyrocket........and that will change.  But unfortunately, as luck would have it, we're all just a little ahead of our time. 

;O)

bob 

LynL

Get electrolytes into your routine! My ostomy dietician recommended Liquid IV and DripDrop. I only need DripDrop once or twice a week now but in early days post op I used it once a day. I also keep Kinderlyte on hand, which is sort of my “emergency” ration. If I get so dehydrated I feel faint I throw that in my water bottle. 

SheriFoster53

My most favorite product for staying hydrated or rehydrating, that’s not flavored and loaded with sugar or Stevia 🤢is Ketochow drops. Put some in my water almost daily. I have an Ileostomy so dehydration is always a huge concern. This has actually kept me out of the hospital for IV fluids. I found mine on Amazon. Calories, lately this has been an issue (never in the past), and I literally just bought a 6 pack of chocolate Kate Farms organic plant based nutrition drink. I haven’t tried it yet, but reviews were promising. I’m not a vegan, just happens to be plant based.