This topic is about managing a high-output ileostomy and dealing with recurrent electrolyte imbalances. A person who recently had ileostomy surgery is experiencing high stoma output, which is causing dangerously low levels of potassium, sodium, and calcium. This situation has led to frequent emergency room visits and significant disruptions to daily life. Despite taking medication and following dietary advice, the problem persists. A possible reversal surgery is planned in about nine weeks, and practical strategies are needed to control the output, stay hydrated, and maintain electrolyte balance.

Here are some helpful tips and insights:

1. Output-thickening foods and medication:
- Continue using Imodium (loperamide) and incorporate stoma-slowing foods like bananas, white potatoes, pasta, and marshmallows or gelatin.
- Reducing or temporarily eliminating excess liquids, especially decaf coffee and tea, can help decrease watery output.

2. Fluid and electrolyte replacement:
- Sip plain water with a pinch of table salt or use oral rehydration drinks like home-mixed Gatorade or water with electrolyte tablets.
- Eating naturally salty foods can be more effective than salt tablets for raising sodium levels.
- Limit total fluid intake if output is high; small, frequent drinks can help maintain electrolyte balance.

3. Diet investigation and professional support:
- Work with a dietitian experienced in inflammatory bowel disease to tailor your diet and identify trigger foods.
- Consider a low-FODMAP elimination plan to identify poorly absorbed sugars and carbs that may cause issues. Reintroduce foods one at a time while monitoring output.
- Keep a detailed diary of food intake and output to identify patterns.

4. Medical follow-up and testing:
- Check which sections of the small bowel were removed and request targeted lab tests to identify malabsorption or enzyme deficiencies.
- Ensure you have written guidance on hydration without a functioning colon and realistic timelines for reversal surgery.

5. Medication load limits:
- Some patients with very high output use up to 24 Imodium per day under medical supervision. If current dosing is ineffective, discuss other options like codeine, tincture of opium, or octreotide with your doctor.

6. Meal pattern adjustments:
- Eating multiple small meals instead of large portions can slow transit and reduce high output.

7. Peristomal skin protection for liquid output:
- Change your appliance every three days to minimize leakage-related skin issues.
- Avoid stoma powder if it affects wafer adhesion.
- Cleanse with diluted isopropyl alcohol to stop itching and aid healing.
- Treat raw areas with Mercurochrome or prescription steroid nasal spray for healing and better adhesion.
- Use a barrier ring under a drainable pouch for added protection.

8. Mind-set and community:
- Many long-term ileostomates manage high output successfully. Taking it one day at a time and seeking peer support can help make the wait for reversal surgery more manageable.