Early Postoperative Dehydration and Electrolyte Imbalances Following Ileostomy Creation

Manoochehry, Shahram; Fazeli, Mohammad Sadegh; Keshvari, Amir; Keramati, Mohammad Reza; Kazemeini, Alireza

doi:10.30491/tm.2023.395226.1589

Early Postoperative Dehydration and Electrolyte Imbalances Following Ileostomy Creation

Document Type : Original Article

Authors

Shahram Manoochehry ¹^{, 2}

Mohammad Sadegh Fazeli ¹^{, 3}

Amir Keshvari ¹^{, 3}

Mohammad Reza Keramati ¹^{, 3}

Alireza Kazemeini ¹^{, 3}

¹ Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran

² Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.

³ Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran

10.30491/tm.2023.395226.1589

Abstract

Introduction
Ileostomy creation is a relatively standard procedure in colorectal surgeries. This study aimed to evaluate the prevalence and severity of dehydration and electrolyte imbalances and find their relationship with patients' demographic and predisposing factors.
Methods
From April 2018 to February 2020, 256 patients who underwent ileostomy creation surgery in the colorectal ward of Imam Khomeini University Hospital (a tertiary center), Tehran, Iran, were enrolled in this study. All patients underwent standard postoperative care and colorectal nursing care. After the ileostomy started to work, patients were evaluated for daily stoma discharge volume and the serum levels of sodium (Na), potassium(K), Magnesium (Mg), Calcium (Ca), Blood urine Nitrogen(BUN), and Creatinine.
Results
Of 256 enrolled patients, three died during the first post-operation period. About 88% of ileostomy started working on the first and the second postop days. There were 64(25.2%) patients with HOI during the index admission and 7(2.7%) patients with prolonged hospital stays (> five days P.O.) only because of HOI. The dehydration rate was highest on the 4th P.O. day; then dehydration was highest on the 5th P.O. day, followed by the third day. Altogether there were 108(28.1%) hyponatremia cases in the index admission, with the highest rate on the 4th P.O. day. Altogether, 99 (25.8%) hypokalemia were in the index admission.
Conclusion
The most prevalent electrolyte imbalance in early PO-readmitted patients was hyponatremia, followed by hypokalemia. Hyperkalemia, hypernatremia, and hypermagnesemia were solely found in readmitted patients and not in the index admission. Early PO readmission with HOI and dehydration was independently associated with Age>60y, Male sex, BMI>30, and living alone status.

Keywords

Dehydration

Electrolyte imbalances

Ileostomy

Subjects