This topic is about managing severe electrolyte imbalance and poor appliance adhesion for someone with an ileostomy and short bowel syndrome. The person in question is experiencing significant health challenges, including being underweight, having a fast and watery output, and dealing with skin irritation due to appliance failure. Here are some helpful suggestions and insights to address these issues:

1. Slow the Output and Improve Absorption
- Consider using Imodium (Loperamide) two to three times daily to help thicken the output and allow more time for nutrient and electrolyte absorption.
- Homemade or commercial oral rehydration solutions can be beneficial for replacing electrolytes and fluids, which also supports better absorption.

2. Optimize IV and Infusion Support
- Ensure that the infusion company customizes the electrolyte content accurately, as the quality can vary significantly between providers.
- If electrolyte issues persist, it may be necessary to have the formula reviewed thoroughly by the provider’s clinical team.

3. Seek Specialist Guidance
- Reach out to ostomy nurses provided by major manufacturers or Nu-Hope Labs for personalized product recommendations. You can send photos for remote evaluation.
- The United Ostomy Associations of America (UOAA) offers virtual ostomy support sessions, which can be accessed for a fee.

4. Improve Pouch Adhesion on Fragile Skin
- Experiment with different wafer brands, as each adhesive may work differently on various skin types.
- Consider using a skin-bonding spray or liquid adhesive under the wafer, available from standard ostomy suppliers.
- Use a barrier ring to create a secure seal. Options include Salts Healthcare Aloe Rings (if available) or Coloplast Brava Ring, which is locally available.
- Warm the wafer and barrier ring with a hairdryer for about 30 seconds before application to enhance adhesion.
- Clean the peristomal skin with water only, and ensure it is completely dry by patting or air-drying gently.
- Use an adhesive-remover wipe or spray to carefully remove the appliance, protecting the delicate skin.
- Consider using half-moon support strips or an ostomy hernia belt with a stoma opening to keep the system securely in place.

5. Treating Damaged Skin
- Lightly dust irritated areas with stoma powder, cover with Duoderm dressing, and then apply the Brava Convex Protective Seal and the warmed pouch.
- Repeat this process until the skin heals, and continue using barrier rings to prevent output from contacting the skin.

These steps aim to provide some relief and improve the quality of life for someone dealing with these complex health issues.