Table 3

 Summary of management of a patient with a jejunostomy*

*The same management applies for management of high output enterocutaneous fistula (providing there is no ongoing intra-abdominal sepsis) and for “ileostomy diarrhoea”.
• Exclude/treat causes other than a short bowel (for example, infection (intra or extraluminal), partial obstruction, abrupt stopping of drugs) (grade C)
• Correct dehydration with intravenous saline while the patient takes nothing by mouth for 24–48 hours. This stops thirst and thus the desire to drink (grade C)
• Reduce oral hypotonic fluids to 500 ml/day. This is the most important measure (grade B)
• Give glucose/saline solution to sip (sodium concentration at least 90 mmol/l). Most stomal/fistula losses (except from the colon) have a sodium concentration of about 100 mmol/l (grade B)
• Add sodium chloride to any liquid feeds to make the sodium concentration near to 100 mmol/l while keeping osmolality near 300 mosmol/kg (grade B)
• Give drugs to reduce motility; loperamide 2–8 mg (non-sedative and non-addictive) before food. Occasionally, addition of codeine phosphate further reduces stomal output (grade B)
• If there is net “secretory” output (generally more than 3 l/24 hours), drugs that reduce gastric acid secretion (H2 antagonists or proton pump inhibitors) or if unable to absorb oral drugs, octreotide can reduce stomal output by 1–2 l/24 hours (grade A)
• Other measures include:
    Separating solids and liquids (that is, having no drink for half an hour before or after food) (grade C)
    Using salt capsules instead of glucose/saline solution (grade B)
    A trial of fludrocortisone if the ileum remains (grade B)
• Correct hypomagnesaemia (see table 6)
    Intravenous magnesium sulphate initially then oral magnesium oxide and/or 1-alpha cholecalciferol (grade B)