Factors Regulating Sodium Balance in Proctocolectomized Patients with Various Ileal Resections

Abstract

Patients subjected to proctocolectomy together with an ileal resection will lose increased amounts of sodium with the ileostomy excreta and may develop sodium and water depletion. Studies of sodium balance and measurements of renin activity, aldosterone, and arginine vasopressin in plasma were made in 23 such patients, 8 of them under metabolic-ward conditions while receiving various salt loads. Salt loss never resulted in subnormal sodium levels in serum. The earliest sign of salt depletion was a nearly total inhibition of renal sodium excretion, which could precede activation of the renin-aldosterone axis in these patients. Secretion of vasopressin remained unaffected by sodium-water depletion and by activation of the renin system. The routine monitoring of these patients should include measurements of renal sodium excretion. Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency.

A Single Urine Sodium Measurement May Validly Estimate 24‐hour Urine Sodium Excretion in Patients With an Ileostomy

“…If sodium depletion is identified, it may be treated with parenteral fluid support or with dietetic advices such as restriction of hypo‐osmolar and hyperosmolar beverages, increased intake of oral rehydration solutions, and sodium loading. Natriuresis has been shown to increase, whereas aldosterone levels decrease, when administering 1000 mL/d of a glucose/electrolyte solution or 250 mmol sodium/d …”

Nutritional and Metabolic Consequences of Extensive Bowel Resection

“…A sodium deficiency in the body is met by an increased secretion of aldosterone which may decrease urinary losses to almost zero. In our ileostomy patients, we found a 10-to 15-fold increase in aldosterone secre tion in those with the most extensive ileal resection [27].…”

Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

“…This result coincided with that in a previous study by Huber et al that reported increased plasma levels of aldosterone in patients after total colectomy 8) . Delin et al reported the shorter length of small bowel after proctocolectomy with various ileal resections, the more the increase in plasma levels of renin and aldosterone after the operation, and they concluded that measurement of renin and aldosterone levels should be used for evaluation of the severity of sodium deficiency 9) . We hypothesize that renin and aldosterone levels increase to compensate for loss of sodium associated with total proctocolectomy and the IPAA.…”

“…The patients were assigned randomly into two groups using a table of random numbers. The patients in group A initially ingested ORS (Na + 50 mEq/L, K + 20 mEq/L, Cl 50 mEq/L, Mg 2+ 2 mEq/L, P 2 mmol/L, Lactate 31 mEq/L, Glucose 1.8%) (1000 mL/day) for the first 7 days (days 1-7) and mineral water (Na + 0.49 mEq/L, K + 0.046 mEq/L, Mg2+ 0.44 mEq/L, Glucose 0%) (1000 mL/day) was given for the next 7 days (days [8][9][10][11][12][13][14]. Conversely, patients in group B initially drank mineral water (1000 mL/day) for the first 7 days and ORS (1000 mL/day) was given for the next 7 days.…”

“…Hyperaldosteronism was observed after total colectomy in rats and after IPPA in humans 7,8) . Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency 9) . The use of oral rehydration solution (ORS) revolutional- ized the management of acute diarrhea 10) .…”