Intracellular electrolyte depletion in patients with ileostomies.

Turnberg, L A; Morris, A. I.; Hawker, P C; Herman, K; Shields, R. A.; Horth, C. E.

doi:10.1136/gut.19.6.563

Cited by 26 publications

(7 citation statements)

References 15 publications

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“…Even if the results of the single patient with Crohn's disease are excluded from our study, the findings remain unchanged. It is of interest that the present study has shown a significant reduction in total body potassium in ileostomy patients similar to that reported by Turnberg et al 9 As the reduction is of the same magnitude for both our groups of ileostomists, this suggests that it is attributable to proctocolectomy alone rather than to ileal resection. Furthermore, accompanying the fall in total body potassium there were comparable reductions in total body nitrogen in both groups of patients, and together these findings indicate a reduction of fat free mass.…”

Section: Discussionsupporting

confidence: 91%

Body composition in ileostomy patients with and without ileal resection.

Cooper¹,

Laughland²,

Gunning³

et al. 1986

Gut

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SUMMARY Body composition was measured in 24 patients who had previously undergone proctocolectomy and ileostomy. One group (control group) had undergone resection of only small amounts of terminal ileum (median 4 cm), the other group of patients (resected group) had undergone resection of greater lengths of small bowel (median 54 cm). These values of body composition were then compared with predicted values in normal subjects. Proctocolectomy and ileostomy without ileal resection did not significantly affect body weight, or the body contents of fat or water, but led to a reduction in total body nitrogen and total body potassium, suggesting a reduction in fat free mass. A modest resection of the terminal ileum undertaken during the course of proctocolectomy decreased body weight largely because of a reduction in body fat. None of the ileostomy patients was found to be dehydrated.

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Section: Discussionsupporting

confidence: 91%

Body composition in ileostomy patients with and without ileal resection.

Cooper¹,

Laughland²,

Gunning³

et al. 1986

Gut

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“…9 In healthy volunteers, experimentally induced sodium depletion was followed by a decreased ability to taste, anorexia, nausea, cramps, exhaustion, and impaired mental functions, as well as weight loss and a negative nitrogen balance. 10 Although patients with an ileostomy may appear healthy and have normal plasma sodium values, 1,3,11,12 careful interviewing may reveal such symptoms, and symptoms resolve following sodium repletion. 13 Sodium and fluid balances are mainly regulated renally through neurohumoral and pressure-mediated mechanisms as a response to the total body sodium and the effective extracellular volume.…”

Section: Introductionmentioning

confidence: 99%

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

Pedersen

Rud

Wilkens

et al. 2019

J Parenter Enteral Nutr

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Background Sodium deficiency in patients with an ileostomy is associated with chronic dehydration and may be difficult to detect. We aimed to investigate if the sodium concentration in a single spot urine sample may be used as a proxy for 24‐hour urine sodium excretion. Methods In a prospective observational study with 8 patients with an ileostomy and 8 volunteers with intact intestines, we investigated the correlations and agreements between spot urine sodium concentrations and 24‐hour urine sodium excretions. Spot urine samples were drawn from every micturition during 24 hours, and relevant blood samples were drawn. All participants documented their food and fluid intakes. Results There was a high and statistically significant correlation between 24‐hour natriuresis and urine sodium concentrations in both morning spot samples (n = 8, Spearman's rho [ρ] = 0.78, P = 0.03) and midday spot samples (n = 8, ρ = 0.82, P = 0.02) in the patients with an ileostomy. The agreement between methods was fair (bias = −1.5, limits of agreement = −32.3 to 29.4). There were no statistically significant associations for evening samples or for samples from volunteers with intact intestines independently of time of day. Conclusion A single spot urine sodium sample obtained in the morning or midday may estimate 24‐hour urine sodium excretion in patients with an ileostomy and thus help to identify sodium depletion.

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“…Increased effluents generally result in a loss of water and salt in patients undergoing total colectomy, conditions which stimulates the renin-angiotensinaldosterone system and consequently increases the level of aldosterone production (Gallagher et al 1962). In our clinical study at Tohoku University Hospital, the majority of colectomized patients demonstrated high plasma aldosterone concentration as compared with normal subjects (unpublished observations), although there are some conflicting reports claiming that aldosterone concentrations are within normal limits in ileostomates (Issacs et al 1976;Turnberg et al 1978). Our present study indicates that circulating aldosterone acts not only on the kidney but also on remnant ileum, and increased and/or de novo expression of mineralocorticoid receptor and increased aldosterone output may play an important role in intestinal adaptation in these patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Expression of Mineralocorticoid Receptor in Human Ileum after Total Colectomy: Immunohistochemical and Immunoblotting Studies.

Fukushima

Sasano

Sasaki

et al. 1994

Tohoku J. Exp. Med.

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Aldosterone is known to regulate transmembrane ion transport and water absorption through its binding to mineralocorticoid receptor (MR) in the mammalian colon. A possible roles of aldosterone has been suggested in increased water absorption from remnant ileum in the patients with total colectomy. We, therefore, studied immunolocalization of MR in remnant ileal mucosa in the patients with total colectomy in order to study the role of aldosterone in water and sodium absorption in these patients. Immunohistochemical localization of MR was performed in ileal mucosa of 7 patients with total colectomy and 5 cases of normal ileum obtained from the resection of ascending colon due to carcinoma by using a polyclonal antibody raised against a mineralocorticoid receptor fusion protein as a primary antibody and a biotinstreptavidin system for immunostaining. Immunoblotting was also performed. Positive MR immunoreactivity was observed in both cytoplasm and nucleus of absorptive cells of ileum of total colectomy patients but not in control normal ileum. Immunoblotting revealed the presence of an approximately 100 kDa immunoreactive product corresponding to mineralocorticoid receptor. Aldosterone is considered to act on ileal mucosa following total colectomy and the aldosterone dependent sodium transport and water absorption may be accelerated in ileal mucosa after total colectomy, which is consistent with the postoperative decrease in the stool volume observed in these patients. In conclusion, increased expression of the mineralocorticoid receptor in remnant ileum may play an important role in intestinal adaptation in total colectomized patients. mineralocorticoid receptor; immunohistochemistry; human intestine; total colectomy; intestinal adaptation

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Intracellular electrolyte depletion in patients with ileostomies.

Cited by 26 publications

References 15 publications

Body composition in ileostomy patients with and without ileal resection.

Body composition in ileostomy patients with and without ileal resection.

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

Increased Expression of Mineralocorticoid Receptor in Human Ileum after Total Colectomy: Immunohistochemical and Immunoblotting Studies.

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