Patients with high-output small bowel
ostomies are at risk for total body
sodium depletion (TBSD), defined as a urine
sodium level <10 mmol/L.
Failure to thrive (FTT) as a consequence of TBSD has been reported in neonates with
ileostomies; however, this has not been well described in older children. The records of all children beyond the age of infancy with a small bowel
ostomy cared for in our Children's Intestinal Rehabilitation Program from 2010-2012 were reviewed. Four patients between the ages of 18 months and 19 years were identified as having TBSD. All 4 patients experienced unintentional
weight loss, despite adequate energy intake based on calculated needs, which was associated with a urine
sodium level ≤10 mmol/L. With the supplementation of
sodium, either enteral or intravenous, all patients demonstrated improved
weight gain and correction of TBSD. The following cases suggest that the relationship between TBSD and FTT may extend well beyond the neonatal period and possibly into adulthood. We advise that patients of all ages with high stoma output have routine urine
sodium levels checked, particularly in the setting of
weight loss or poor gain. Furthermore, instances of TBSD should be treated with
sodium supplementation. Further research is needed to better understand the relationship between TBSD and FTT and to establish intervention guidelines.