This topic is about managing hypomagnesemia, which is a condition of low magnesium levels, in individuals with a high-output ileostomy, Crohn’s disease, and fistulas. These conditions can make it difficult for the body to absorb and retain nutrients, particularly magnesium. Here are some insights and advice shared by others dealing with similar challenges:

1. Current Prescription and Challenges:
- Magnaspartate powder is currently prescribed, but it has a laxative effect and is poorly absorbed.
- Medications like loperamide and codeine are used to slow output, but the output remains high.
- IV magnesium infusions are effective but not a sustainable long-term solution.
- Exploring chewable magnesium tablets, though not all are available through the NHS.

2. Dietary Considerations:
- Foods high in magnesium are often high in fiber, which can worsen stoma output.
- Trying magnesium citrate gummies and magnesium malate powder, which is advertised as having the least laxative effect.
- Recognizing symptoms of low magnesium, such as nausea, fatigue, and loss of appetite.

3. Suggestions for Managing Magnesium Levels:
- Incorporate binding foods like porridge, potatoes, and rice to help slow output.
- Consider magnesium formulations with lower laxative potential, such as Magnesium Oxide, di-magnesium malate, and magnesium chelate.
- BioOptimizers "Magnesium Breakthrough" and Mag-G tablets are options that may not increase output.
- Transdermal options like magnesium oil or spray, and soaking feet in a magnesium bath, can bypass the gut.
- "ReMag" is an ionic liquid that may bypass the digestive tract.

4. Strategies to Slow Stoma Output:
- Lomotil may be more effective than loperamide for some individuals.
- Metamucil or similar bulking agents can help thicken the output.

5. Hydration and Electrolyte Maintenance:
- Drip Drop ORS can help delay the need for IV infusions when used with magnesium supplements.
- Regular blood tests are recommended to monitor electrolyte levels.

6. Testing and Caution:
- A simple serum magnesium blood test can confirm absorption issues.
- Long-term IV access can resolve magnesium issues temporarily but carries infection risks, so oral or transdermal strategies are preferred to avoid hospital readmissions.