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Acute electrolyte and acid-base disorders in patients with ileostomies: a case series.

BACKGROUND: Patients with ileostomies are well known to be susceptible to extracellular fluid volume depletion as a result of fluid and solute losses that are greater than intake. However, electrolyte and acid-base disorders accompanying these episodes of volume depletion are not well delineated.

STUDY DESIGN: Case series.

SETTING & PARTICIPANTS: 7 patients with hospitalization because of acute acid-base disturbances at an academic medical center.

OUTCOMES: In all patients, serum and urine creatinine and electrolytes were measured. In 2 patients, arterial blood pH and Pco(2) and ileal drainage electrolytes also were measured.

RESULTS: 2 patients presented with severe metabolic alkalosis, and the remaining 5 patients had low serum total carbon dioxide values in association with hyperkalemia. All 7 had acute renal failure. Pathophysiological characteristics, diagnosis, and management of these disorders are discussed, along with considerations for long-term management of fluid and electrolyte balance.

LIMITATIONS: This report illustrates electrolyte and acid-base disorders encountered in patients with ileostomies from our clinical experience. We have no data about the incidence of these disorders.

CONCLUSION: Patients with ileostomies can develop diverse and potentially life-threatening acute electrolyte and acid-base disorders when ileostomy drainage increases. Either metabolic acidosis or metabolic alkalosis can occur, depending on the nature and duration of the losses. These cases emphasize the need to be aware of the variety of acute electrolyte and acid-base disorders that can occur in this group of patients and to intervene rapidly when they develop.

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