Sodium needs of infants and children with ileostomy

We studied gastrointestinal tract excretion of sodium and water in seven infants with an abdominal ileostomy (group 1) and three children with a Soave ileoendorectal pull-through (group 2). When the daily sodium intake of the patients was 5 to 7 mEq/kg (twice usual maintenance), average daily ileal sodium losses were 2.4 mEq/kg body weight in group 1 and 3.3 mEq/kg in group 2. Ten days after ileostomy closure in group 1, when the infants' daily sodium intake averaged 2 to 3 mEq/kg/day, gastrointestinal tract sodium losses were reduced to 0.3 mEq/kg body weight/day. The mean daily fecal weight and water also decreased after closure. Mean serum aldosterone concentration before closure was 84 ng/ml, and declined to 58 ng/100 ml after closure; and mean plasma renin values fell from 8.8 to 2.9 ng/ml/hr. In the children with an ileoendorectal pull-through, daily sodium intake was restricted to 0.3 to 0.5 mEq/kg/day, an amount that would maintain balance in a child of similar age with normal sodium conservation. Mean serum aldosterone concentration increased to 501 ng/ml (normal 1 to 22.7). Although renal conservation of sodium occurred promptly, gastrointestinal losses of sodium and water continued and the patients' sodium balance became negative. The diet of a patient with an ileostomy should include increased amounts of sodium until bowel continuity is restored.