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OSMOLALITY IN ORAL SUPPLEMENTS DRIVES ILEOSTOMY OUTPUT: DEFINING THE GOLDILOCKS ZONE

Josephine Reinert Quist 1, Charlotte Lock Rud 1, Mette Julsgaard 1, Karen Frumer 1, Simon Mark Dahl Baunwall 1, Christian Lodberg Hvas 1

Affiliations

1 Aarhus University Hospital, Aarhus N, Denmark

Summary

AI Generated

A quasi-randomized crossover study in 14 ileostomy patients found that oral supplement osmolality correlates with ileostomy output, with a proposed optimal absorption range of 100-290 mOsm/kg.

In the osmolality range of 290-600 mOsm/kg, ileostomy output increased by 57g per 6 hours for every 100 mOsm/kg increase in oral supplement osmolality (95% CI 21-94, p<0.005).
The association between osmolalities spanning 5-1352 mOsm/kg and ileostomy output forecasted an S-curve pattern.
The authors suggest oral supplements with osmolalities between 100 and 290 mOsm/kg may optimize fluid absorption in ileostomy patients, terming this the Goldilocks zone.
The single-center study enrolled 14 adult ileostomy patients (median age 64.5 years, range 22-77) without home parenteral support who underwent fasting, standardized ingestion of 500 mL oral supplements, and 6-hour output collection.
This work is relevant to clinicians managing ileostomy patients experiencing sodium depletion, secondary hyperaldosteronism, or impaired quality of life.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Patients with an ileostomy often have impaired quality of life, sodium depletion, secondary hyperaldosteronism, and other organ-specific pathologies. The osmolality of oral supplements influences ileostomy output and sodium loss.

Aims & Methods

We hypothesized the existence of an osmolality range where fluid absorption and secondary natriuresis are optimal. This was a single-center, quasi-randomized crossover intervention study, including patients with an ileostomy and no home parenteral support. After an 8-hour fasting period, each patient ingested 500 mL of between 3 and 18 different oral supplements and a standardized meal during separate intervention periods, followed by a 6-hour collection of ileostomy and urine outputs. The primary outcome was 6-hour ileostomy output.

Results

A total of 14 adult patients with an ileostomy (median age 64.5 years (range 22 - 77)) were included. The association between osmolalities in the entire range of 5-1352 mOsm/kg and ileostomy output forecasted an S-curve. In a mixed-effect model with the patients as a random effect, we observed a linear association between the osmolality of oral supplements in the range of 290-600 mOsm/kg and ileostomy output, which increased with 57g/6 hours (95% CI 21 – 94) when the oral supplement osmolality increased 100 mOsm/kg (p<0.005).

Conclusion

Osmolality in oral supplements correlated with ileostomy output in patients with an ileostomy. Our results indicate that patients with an ileostomy may benefit from increasing their ingestion of oral supplements with osmolalities between 100 and 290 mOsm /kg. We suggest this range is called the Goldilocks zone, indicating optimal fluid absorption.

Disclosure

This work was supported by Helga and Peter Kornings fond, Aarhus, Denmark, and the A. P. Møller fonden, Copenhagen, Denmark. Josephine R. Quist have received financial support from Aarhus University for PhD courses and biostatistical advisory service (BIAS). Aarhus University have not had any input to or influence on the manuscript preparation. CH received funding from Novo Nordisk Foundation (grant no. NNF22OC0074080).

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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