This topic is about managing a high-output ileostomy while trying to stop using total parenteral nutrition (TPN). A person with an ileostomy is experiencing a high volume of output, which is making it difficult to discontinue TPN. Here are some helpful insights and advice for managing this situation:

1. **Loperamide Dosing**:
- For high-output stomas, much higher doses of loperamide than usual might be necessary. Some clinical guidelines suggest doses up to 64 mg per day, divided across meals and bedtime. In very challenging cases, up to 96 mg per day has been used. It's crucial to only increase the dose under medical supervision.

2. **Timing of Imodium**:
- Continue taking Imodium 20 to 30 minutes before meals to maximize its effectiveness.

3. **Additional Medications**:
- Consult with your healthcare team about the possibility of adding other medications that can help reduce output if loperamide alone isn't enough.

4. **TPN Adjustments**:
- Consider asking if the TPN infusion time can be shortened, for example, from 14 hours to 12 hours, to allow more freedom during the day.
- If more weight gain is needed, the calorie concentration in the TPN bag can be increased instead of extending the infusion time.

5. **Hydration Strategies**:
- Since high output is a major cause of dehydration, managing it should help improve overall fluid balance.

6. **Diet for Weight Gain**:
- When eating is possible, consider high-calorie, high-fat snacks like chips, crisps, cream cakes, and chocolate, but always follow the guidance of a dietitian.

The person is currently taking liquid Imodium three times a day and using Liquid IV electrolyte powder for hydration. They have gained about 20 pounds on TPN but face dehydration issues when TPN is stopped. They also wish to return to aquatic aerobics but are unable to due to the presence of a PICC line.