Advice Needed for Electrolyte Imbalance and Ostomy Adhesion Issues

My mom has an ileostomy and short bowel syndrome after undergoing five abdominal surgeries. She is currently extremely underweight and completely dependent on daily IV infusions due to a persistent electrolyte imbalance.

We're also facing serious issues with her ostomy appliance not sticking properly. Her skin is very fragile, and even the extra adhesive (half-moon strips) and stoma paste haven't helped; the flange keeps peeling off.

Has anyone dealt with severe electrolyte imbalance in similar cases?

What helped stabilize things?

Also, any tips or products that worked for sticking an ileostomy bag to very thin, fragile skin?

Thank you in advance.

Try different product brands; some may stick better to her skin than others.

Also, I use a skin bonding adhesive in addition to the adhesive on the product. This or something like it may help. I get this through my regular ostomy supply vendor.

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Thank you so much! I will try to find it here.
Thank you ❤️

Hi there, There is another member here with short bowel syndrome, and hopefully, he will chime in. I have an ileostomy and lately have been having issues with low sodium and magnesium. I'm taking Imodium (Loperamide) to slow my output down and thicken it up. Your mom could try this, as keeping nutrients in her body long enough to be absorbed is the issue. I take Imodium two or three times throughout the day, and it helps. As far as skin issues and making things stick, make sure she is getting her peristomal skin really clean and completely dry before applying the appliance. A good barrier ring will help, and I recommend Salts aloe rings if they are available to you. The Salts Aloe rings are also very gentle on the skin and will help with irritation. Using a hair dryer to warm the surface of the wafer for around 30 seconds, just before applying it, can also help. Good luck.

Terry

Hi Maja,

Electrolytes are primarily absorbed in the small bowel...........so if your mom is missing a significant portion of hers, she'll have issues with electrolyte retention. The other place they're absorbed is in the colon, but if she has an ileostomy, then her colon is no longer in the game either. If she's extremely underweight, I'm assuming she's on TPN or PPN......no? If so, the infusion company that prepares her infusion formula and IV hydration should be addressing her electrolyte issue in her formulations. Having a good infusion company to work with is very, very important, as they are NOT all the same. Let me know what your mom's situation is regarding TPN or PPN.

In terms of the appliance not sticking...........are you working with an ostomy nurse? If there's none available, you can call any of the major ostomy supply manufacturers and talk to their ostomy nurses for free. I'd also recommend you talk to an ostomy nurse at Nu-Hope Labs. They're very knowledgeable and deal with extreme cases and people with significant problems. I'll put their link below. Be careful with your mom's skin.........it sounds very thin, which complicates things. I'm not going to suggest any specific products because some might do more harm than good when her skin is like that. Send pics to whichever ostomy nurses you decide to deal with so they can see exactly what's going on. Keep us updated.

https://nu-hope.com/

;O)

How to Adjust to Life with an Ostomy with Bruce | Hollister

Hi Terry, thank you!
She had been using Loperamide for about 20 days, but then had to return to the hospital, where she was treated by a different doctor. He gave her only infusions, along with magnesium and calcium. I spoke with a doctor today and asked for a new prescription for Loperamide.

Unfortunately, we don't have Salts Aloe Rings available in Bosnia, but something similar from Coloplast—Brava—is expected to arrive at the pharmacy soon, so we'll give that a try.

As far as I understand, it goes around the stoma like plasticine, and then a disc and bag are applied on top. Is that correct?

Her last surgery was in December; her small intestine ruptured, and since then, she's been managing mostly with IV infusions; you could say partial PPN. At one point, she was also on TPN. She has a good appetite now, but everything passes through so quickly and ends up in the bag right after she eats.

Her colon has been preserved, but the doctor is hesitant to operate again, saying she's too weak and might not wake up from the anesthesia.

Unfortunately, we don't have a nurse specialized in stoma care here. I've been trying to find more information online, like YouTube tutorials. The hospital nurses have only basic knowledge, and they're often in a rush when handling the stoma; they wipe the skin quite roughly and don't have much time for careful care.

Now my mom is running out of veins for IVs, so my goal is to help her regain absorption as soon as possible, or even consider surgery if the colon could still be of some help.
She's also now starting to experience kidney issues, dizziness, and urinary infections, all likely consequences of dehydration.

Thank you so much for recommending Nu-Hope Labs; I'll definitely check it out.

UOAA is a US ostomy advocacy group. They offer a virtual ostomy support option. It does not say you need to be in the US, but it does have a fee which may be out of reach for you; I'm not sure of the exchange rates. So this may not work for you, but I wanted to at least mention it.

I'm really concerned about the hydration issues and possible kidney damage. Look for hydration solution recipes. I know some of these can be made at home if you are unable to purchase them. I'm hoping one of the ileostomates will come along and make targeted suggestions; I have a colostomy and don't have the specific knowledge.

I was recently told that better hydration will help with absorption in general.

Get adhesive remover for removing the appliance. Clean the skin gently with water only if possible. Dry well; use a fan or blow dryer if available. Apply a barrier ring so that it fits snugly against the stoma and then apply the appliance.

Get a hernia belt designed for stomas; they have a hole you pull the bag through. Nu Hope sells these, but there are other options. The belt will help hold the appliance on her skin.

Your first priority is hydration. Good luck. Let us know how you get on.

https://www.ostomy.org/clinic/

Yes, sort of like plasticine. It's a ring that circles the stoma, hugs it, and adheres to both your skin and the appliance, creating a good seal to keep output from getting on your skin. It should make a big difference.

Terry

Hi Terry, I bought this shaping ring and the adhesive support strips today for my mom, but unfortunately, it's still leaking. Her skin is now all red and sore :(

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Hi. When I had issues, I used Duoderm dressing on the sore skin. After a light dusting of stoma powder.

Then I used Brava Convex protective seal.

Then the bag.
Making sure the seal and bag have been warmed, which helps the adhesion.

I hope this helps.