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Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy
T R Bower1, K C Pringle, R T Soper
1Department of Surgery, University of Iowa Hospital and Clinics, Iowa City 52242.
Insights
Infants with ileostomies risk sodium depletion and metabolic acidosis due to fluid losses. Supplementation with sodium chloride (NaCl) and sodium bicarbonate (NaHCO3) is crucial for adequate growth and correcting acidosis.
Area of Science:
- Pediatric Surgery
- Neonatology
- Pediatric Gastroenterology
Background:
- Ileostomies in infants, often resulting from necrotizing enterocolitis (NEC) or meconium ileus (MI), can lead to significant fluid and electrolyte losses.
- Metabolic abnormalities, including total body sodium depletion and metabolic acidosis, are frequently observed in these neonates due to bicarbonate loss in ileostomy output.
Purpose of the Study:
- To review metabolic abnormalities in infants with ileostomies related to ileostomy fluid losses.
- To determine the impact of sodium depletion on infant growth and metabolic status.
- To establish guidelines for sodium supplementation in infants with ileostomies.
Main Methods:
- Retrospective review of 11 infants (25-38 weeks gestation) who underwent ileostomy for NEC or MI.
- Analysis of clinical data including weight, age, ileostomy output, serum electrolytes, and acid-base status.
- Correlation of ileostomy output with sodium intake requirements for adequate growth.
Main Results:
- All infants experienced sodium depletion and metabolic acidosis from ileostomy fluid losses.
- Seven infants required sodium supplementation; six showed improved weight gain and acidosis after receiving NaCl or NaHCO3.
- A direct relationship was found between ileostomy output and required sodium intake, with a formula derived: Na intake = 1.2 + (0.13 x ileostomy output).
Conclusions:
- Infants with ileostomies are at high risk for total body sodium depletion, metabolic acidosis, and inadequate weight gain.
- Sodium supplementation, combining NaCl and NaHCO3, is essential for managing these complications.
- Monitoring ileostomy output and adjusting sodium intake is critical for ensuring adequate growth in these vulnerable infants.
Abstract:
The records of 11 infants, 25 to 38 weeks' gestation, with metabolic abnormalities induced by ileostomy fluid losses were reviewed. At operation for necrotizing enterocolitis (NEC) (9) or meconium ileus (MI) (2), they weighed between 1,100 and 3,100 g and were from one to 41 days old. All developed total body sodium depletion and metabolic acidosis from ileostomy bicarbonate loss. In seven, sodium depletion was severe enough to require supplementation; six initially lost or failed to gain weight despite being fed adequate diet and calories. However, after receiving sodium supplementation (three with NaCl and three with NaHCO3), these six patients gained weight and improved their metabolic acidosis. The other five subjects did not initially receive sodium supplementation. Four gained weight; one of these later received supplemental NaHCO3 for a metabolic acidosis. The fifth patient failed to thrive until his ileostomy was closed. All infants initially had urine Na less than 10 mEq/L and normal serum Na. All infants whose urine Na rose above 10 mEq/L and had serum HCO3- greater than or equal to 20 mEq/L grew adequately. A direct relationship existed between ileostomy output and sodium intake required for growth. This expressed mathematically (Na intake = 1.2 + [0.13 x ileostomy output] shows a basal sodium need (with no ileostomy output) of 1.2 mEq/kg/d and an additional requirement of 0.13 mEq/kg/d of sodium for each mL/kg/d of ileostomy output. We conclude that infants with ileostomies are at extreme risk of total body sodium depletion with resultant metabolic acidosis and inadequate weight gain. These infants require sodium supplementation with a combination of NaCl and NaHCO3.(ABSTRACT TRUNCATED AT 250 WORDS)