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Jan 30, 2024

Conflicting Advice on Daily Fluid Intake with Stomas

This topic is about managing fluid and electrolyte intake for someone with two stomas and no large bowel. The person is receiving conflicting advice from their healthcare providers, which has left them unsure about the best approach to take. Here are some helpful insights and advice:

1. Consider a middle-ground approach by aiming for about 1.75 liters of total fluid intake, keeping in mind that individual needs can vary.

2. Using Dioralyte, a UK oral rehydration solution, can be beneficial when you have high output from your stoma, as it helps replace lost electrolytes. The combination of Dioralyte and other drinks might naturally bring your total intake close to 2 liters, aligning with both your consultant's and GP's advice.

3. If you prefer plain water, try to include a variety of other fluids or electrolytes to prevent flushing out salts. Use them occasionally based on your stoma output.

4. For high-output stomas, it's advisable to limit plain water, tea, coffee, and fizzy drinks, as they may pass through quickly.

5. Consult with specialized healthcare providers like stoma or ostomy nurses and dietitians for personalized guidance.

6. Practical hydration tips from others include:
- Sip fluids steadily throughout the day instead of drinking large amounts at once.
- Measure or estimate your stoma output over several days and increase fluid intake if the output rises.
- Other ileostomates report typical fluid intakes ranging from 2 to 3 liters daily without electrolyte imbalances, confirmed by blood tests.
- Some manage on less than 2 liters without issues, highlighting that everyone is different. Monitor your own lab results and symptoms.

7. For electrolyte replacement, consider:
- Pedialyte, though some criticize its taste.
- A homemade mix of 1 part Gatorade (sugared version) to 3 parts water.
- Commercial hydration powders like Dioralyte.
- 500 mg sodium tablets taken twice daily or salted snacks like extra-salt pretzels if your blood sodium is low, but balance this with blood pressure monitoring.

8. To relieve mouth dryness, Oralieve Moisturizing Mouth Gel can increase comfort when fluid intake is limited.

9. General stoma management tips include:
- Without a colon, your hydration needs increase. A common starting recommendation is 64 ounces (about 1.9 liters) per day, taken in small sips.
- Consider using open-end (drainable) pouch systems if your output is very liquid, as this can reduce the need for full bag changes.
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