Observations on serious disturbances of water and electrolyte metabolism in patients with terminal ileostomies.

The management of mechanical complications which may accompany ileostomy has been well described (Warren and McKittrick, 1951; Lahey, 1951, i95oa, I95ob; Hardy et al., 1949; Cave, I946; Cave and Nickel, I940). Information is not readily available about the management of the fluid and electrolyte exchange in patients with recent ileostomies. The various aspects of electrolyte exchange in such cases mentioned in the literature are as follows: Extrarenal loss of sodium in excess of chloride; treatment with sodium chloride and sodium bicarbonate (Welch et al., 1937). Fixed base loss in ileostomy fluid in excess of fixed acids; replacement based on urinary chloride concentration (Coller and Maddock, 1940). Circulatory collapse due to greater loss of fixed base and risk of sodium depletion (Nadal et al., 1941; Randall et al., 1950). Salt depletion (Cave and Nickel, 1940; Cave, I946; Hardy et al., I949). Chloride depletion (Ferguson and Welty, 1947; Michael, 195 ). Potassium depletion in patients who have diarrhoea and intestinal fistulae (Darrow, 1945; Blixenkrone-M1ller, I950; Lockwood and Randall, 1949). Depletion of potassium, water and sodium (Counsell and Goligher, 1952). Our experience has shown that on occasion sodium administration is essential in the aftertreatment of patients with ileostomies and evidence will be presented to show how the water and sodium depletion which may affect such patients may prove extremely serious and how they may be remedied.