A patient with jejunostomy liberated from home intravenous therapy after 14 years; contribution of balance studies.
A patient with a jejunostomy 100 cm from the duodeno-jejunal flexure, following surgery for Crohn's disease, had needed parenteral fluids at home for 14 years because of a negative intestinal balance of sodium. Measurements were made of her oral intake and intestinal output during study periods each of 2 days. Loperamide 4 mg QDS, codeine phosphate 60 mg QDS and both together put her into positive intestinal fluid balance but sodium balance remained negative. Both drugs used together were more effective than either used alone. Ranitidine 300 mg BD made no significant difference to her intestinal output. 1 litre of a glucose-electrolyte solution (120 mmol sodium) sipped during the day resulted in sodium balance, but only with the addition of loperamide and codeine phosphate was positive sodium balance achieved (mean 44 mmol/day). This therapy allowed her to dispense with parenteral fluids which have been stopped for the last year.
Nightingale
J M
JM
St Mark's Hospital City Road, London EC1V 2PS UK.
Lennard-Jones
J E
JE
Walker
E R
ER