Managing High Output with Ileostomy and TPN Challenges

The discussion centers around a person who has been living with an ileostomy for 12 weeks and is experiencing high output, which is complicating their transition off Total Parenteral Nutrition (TPN). The goal is to reduce stool output to 1.2 liters or lower from the current 2 liters. The individual is unable to use fiber supplements like Metamucil due to the risk of blockages and is currently using Imodium to manage output. The high output is also causing dehydration issues, and the person is unable to engage in their preferred exercise, swimming, due to a bad hip and the constraints of TPN.

Advice and Insights

1. Imodium Dosage:
- A double dose of Imodium (4mg) is considered low for high output ostomies. It is suggested to increase the dosage to 64mg/day, taken four times a day (once at each meal and at bedtime). In very difficult cases, up to 96mg/day may be needed.
- It is recommended to take Imodium 20-30 minutes before eating and avoid drinking anything 30 minutes prior or after eating to enhance its effectiveness.

2. TPN Management:
- Consider adjusting the TPN delivery to 12 hours instead of 14 to provide more freedom.
- If weight gain is needed, increasing the caloric intake of TPN might be beneficial.

3. Diet and Supplements:
- High-calorie, low-fiber foods such as chips, crisps, cream cakes, and chocolate can be encouraged to aid weight gain.
- Liquid IV can be used to help with hydration, though some flavors may be more palatable than others.

4. Dehydration Concerns:
- The high output is contributing to dehydration when not on TPN. Increasing Imodium intake can help slow the output and reduce dehydration.
- Monitoring fluid intake is crucial, as drinking too much can lead to increased urination and further dehydration.

5. Exercise Limitations:
- The presence of a PICC line restricts participation in aquatic activities, which is a preferred form of exercise for the individual. An internal line is not an option.