title: Protocol for the detection and nutritional management of high-output stomas.
abstract: BACKGROUND
  An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management.
  
  
  METHODS
  This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery.
  
  
  RESULTS
  Early HOS was observed in 7 (16%) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16%) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100% effectiveness. 50% of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33% of the late HOS patients.
  
  
  CONCLUSIONS
  The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.
authors.affiliation: Clinical Medicine and Health Care PhD programme, University of Granada, Granada, Spain. jjavier.arenas@gmail.com.|Pharmacy and Nutrition Service, A7, km. 187, Hospital Costa del Sol, Marbella (Málaga), 29603, Spain. jjavier.arenas@gmail.com.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Arenas Villafranca
authors.affiliation: Pharmacy and Nutrition Service, A7, km. 187, Hospital Costa del Sol, Marbella (Málaga), 29603, Spain. cristobal_lopez_rodriguez@hotmail.com.
authors.forename: Cristobal
authors.initials: C
authors.lastname: López-Rodríguez
authors.affiliation: Pharmacy and Nutrition Service, A7, km. 187, Hospital Costa del Sol, Marbella (Málaga), 29603, Spain. jimesolea@yahoo.es.
authors.forename: Jimena
authors.initials: J
authors.lastname: Abilés
authors.affiliation: Gastroenterology Service, Costa del Sol Hospital, Marbella (Málaga), Spain. javier_arenas_villafranca@hotmail.com.
authors.forename: Robin
authors.initials: R
authors.lastname: Rivera
authors.affiliation: General Surgery Service, Costa del Sol Hospital, Marbella (Málaga), Spain. ngandara@hcs.es.
authors.forename: Norberto
authors.initials: N
authors.lastname: Gándara Adán
authors.affiliation: Pharmacology Department, University of Granada, Granada, Spain. utrillam@ugr.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Utrilla Navarro
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods; D008275:Magnesium Deficiency / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D011446:Prospective Studies; D054047:Surgical Stomas / Q000009:adverse effects* / Q000473:pathology*