Universität zu Köln

Soehngen, D., Balzer, C., Fuchs, M. and Waldschmidt, D. (2015). Rehabilitation of Patients with Acid-base and Fluid Balance Disorders with Short Bowel Syndrome after Ileostomies. Rehabilitation, 54 (2). S. 86 - 92. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-1309

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Abstract

Background: Patients with ileostomies regularly suffer from short bowel syndrome or high volume output associated with loss of absorptive surface and subsequent impairment of absorption for drugs and different nutrients resulting in electrolyte and fluid balance disorders as well as renal insufficiency. Adaptation of these fundamental functions of the gut with adequate fluid uptake, absorption of sufficient different nutrients and vitamins represents a major challenge to rehabilitate these patients shortly after surgery. Patients with ileostomy often develop metabolic acidosis with normal anion gap. In our retrospective study we would like to draw attention to these metabolic disorders in patients with ileostomy in comparison to patients with colostomy and patients undergoing gastrectomy for gastric cancer. Methods: In the period from 2005 to 2012 we examined 164 patients with ileostomy in our rehabilitation clinic, 109 patients with colostomy and 193 patients after surgery for gastric cancer of the possible presence of metabolic acidosis by using capillary blood gas analysis (metabolic acidosis was anticipated, if base excess was <= -3,0 mmol/l). Patients are treated as inpatients both in early stage and for follow-up rehabilitation. The length of time in our rehabilitation clinic lies inbetween 24-28 days. On the basis of random samples we tested blood samples in 19 patients with ileostomy in succession for ferritin, folic acid, zinc, selenium and vitamin B12. Statistical analysis comprised the classical intervals (mean and standard deviation, range and T-test for dependent and indipendent samples). Results: In total we tested 164 inpatients with ileostomy in our rehabilitation clinic (median age 67.4 years, range 19-79 years). The time for surgery for ileostomy took place about 1.4 months on average ago (range 1/4-56 months). 60 (36.5 %) inpatients suffered from metabolic acidosis often combined with renal insufficiency. Supportive therapy intravenously administered in 10 patients and sodium bicarbonate given by mouth in 40 patients significantly improved metabolic acid (base excess improved on average from -7.2 to -3.2 mmol/l, p < 0.00138) and renal function calculated on the basis of serum creatinine (serum creatinine decreased from 1.49 on average to 1.34 mg/dl, p < 0.04039). Body weight remained constant over the whole period on average with 74 kg. Diuretics did not show any influence on the base excess. In 19 patients with ileostomy who did not take any kind of supplements, among the parameters tested were a high percentage of zinc (9 of 19 patients, 47 %) and selenium deficiency (13 of 19 patients, 68 %). 50 patients with ileostomy were younger than 65 years of age and thus in the working age population. In the group of patients after gastrectomy because of gastric cancer (n = 193, median age 69.1 years, range 36-82 years), the time for surgery for gastrectomy took place about 1.8 months on ave-rage ago and in this group only 14 patients (7 %) showed metabolic acidosis. In the group of patients with colostomy (n = 109, median age 69.5 years, range 39-82 years), the time for surgery for colostomy took place about 2.1 months on average ago and in this group only 6 patients (5.5 %) suffered from metabolic acidosis. Conclusion: Medical rehabilitation is indicated for patients with enterostoma. Acceptance of the enterostoma by the patient himself, psychological stabilization, achievement of self-sufficiency in stoma care, improvement of physical abilities and finally being fit for full or limited employment are the most important objectives in rehabilitation medicine. Metabolic acidosis was often found in patients with ileostomy and was an important clinical appearance. Blood gas analysis is recommended to verify metabolic acidosis and if confirmed sodium bicarbonate and in cases of high volume output salt-depleting ileostomy additionally intravenous fluid support should be offered controlling body weight in the follow-up. As could be shown by our analysis patients with ileostomy should also be tested for zinc and selenium deficiency.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Soehngen, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Balzer, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Waldschmidt, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-408066
DOI:	10.1055/s-0035-1545357
Journal or Publication Title:	Rehabilitation
Volume:	54
Number:	2
Page Range:	S. 86 - 92
Date:	2015
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-1309
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LOOP ILEOSTOMY; IMPAIRMENT; COLOSTOMY; CANCER Multiple languages Rehabilitation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40806