Ileostomy Output: Understanding Normal Fluid Levels & Potential Blockages

Question
I am in hospital and ON jejunal feeds at 35ml hour with tpn 33ml hour. Only other input is water flushes in my J.tube of 300ml total for the day.  My ileostomy output is only 150-180ml A DAY. Is this normal or should it be at 600mls? After my operation for the ileostomy one year ago I was on drip two weeks and the output was 600mls to 1litre.  I'm wondering if there is some type of a blockage in my bowel as I bloat alot and get gas also get pain around the stoma WHEN THE GAS PASSES OUT and ALSO SHARP pains deep in the abdomen always waking. Any ideas? I keep asking if the J feeds can be reduced due to the discomfort but they don't want to stop using my bowel as they think it will stop working as they say I have a motility disorder..  ALSO IMPORTANT IS I gained 4kg after 24hrs OF SODIUM drip and tpn (125ml per hour in total) then gained another 1.5 kg in two days..  Got a lot of fluid retention in my legs..  I suspect another weight gain tomorrow.  These doctors can only think of getting in more nutrition due to my low weight which was 28kg but somehow the fluid retention and weight gain seems too quick..  any ideas of what could cause this?  Would the ileostomy not working much contribute to the weight gain?  Thanks and I appreciate your time and any questions I could put to these doctors.  Am under a Colorectal surgeon, Gastroenterologist and TPN specialists..  regards


Answer
This is a tough one to make a call, since it is so complicated, but in those cases, I try to take a step back and simplify things..... the "poor man's" fluid monitor, is urine output.  If you are putting out 30-50 cc of urine per hour (average), then you are getting enough fluid.  If you aren't, then you are not getting enough fluids.  If the Sodium is causing swelling, then they can use something with more free water, like D5 1/2 NS or D5 1/4 NS.  However, it does sound like you are low on the fluid replacement.  I calculate 1930 cc of fluid per day, which may be slightly on the low side.  One easy way to tell if you are obstructed is if you are vomiting.  The sharp pain could be a partial obstruction or  a million other things.  In general, the Gastro is the one who is probably the best at electrolyte and fluid management.

Hope this helps...