Early changes in serum electrolytes after ileostomy in patients with colorectal cancer: implications for hydration and nutritional care

Andrio Suhadi* -  Specialist Medical Training Program, Department of Surgery, Faculty of Medicine, University of Sumatera Utara, Medan, Sumatera Utara, Indonesia
Asrul Asrul -  Department of Surgery, Faculty of Medicine, University of Sumatera Utara, Medan, Sumatera Utara, Indonesia
Safruddin Safruddin -  Department of Surgery, Faculty of Medicine, University of Sumatera Utara, Medan, Sumatera Utara, Indonesia
DOI : 10.30867/action.v11i3.3485

Ileostomy reduces colonic fluid and electrolyte reabsorption and could increase the risk of early postoperative dehydration and electrolyte disturbances. This study described early changes in serum sodium, potassium, and chloride levels after ileostomy in patients with colorectal cancer and their implications for hydration and nutritional care. This retrospective longitudinal study reviewed medical records at H. Adam Malik General Hospital, Medan, Indonesia, during 2025; data were extracted from April to June 2026. Of 263 patients with ileostomy identified, 75 patients with colorectal cancer who met the eligibility criteria and had complete electrolyte measurements preoperatively and on postoperative days 1 and 3 were analyzed. Global temporal differences were assessed using the Wilcoxon test at α = 0.05. Results, mean sodium decreased from 141.6 ± 5.7 mmol/L preoperatively to 137.9 ± 6.9 mmol/L on day 3, while chloride decreased from 104.7 ± 3.5 to 101.0 ± 9.3 mmol/L; both showed significant temporal differences (p < 0.001). Potassium showed no significant difference (p = 0.573). On day 3, normal sodium, potassium, and chloride values were observed in 56%, 60%, and 68% of patients, respectively. In conclusion, early post-ileostomy electrolyte changes were most apparent for sodium and chloride. These findings support serial electrolyte and hydration monitoring and integration of hydration assessment with nutritional care.

Keywords : Colorectal neoplasms, dehydration, electrolytes, ileostomy, water-electrolyte balance

  1. Andjarwati, R., Gayatri, D., & Afiyanti, Y. (2022). Efektivitas intervensi edukasi nutrisi pada ostomate paska operasi digestif. Journal of Telenursing (JOTING), 4(1), 421–427. https://doi.org/10.31539/joting.v4i1.3524
  2. Assaf, D., Hazzan, D., Ben-Yaacov, A., Laks, S., Zippel, D., & Segev, L. (2023). Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries. Annals of Coloproctology, 39(2), 168–174. https://doi.org/10.3393/ac.2021.00241.0034
  4. Becker, H. M., & Seidler, U. E. (2024). Bicarbonate secretion and acid/base sensing by the intestine. Pflügers Archiv - European Journal of Physiology, 476(4), 593–610. https://doi.org/10.1007/s00424-024-02914-3
  6. Chen, S. Y., Stem, M., Cerullo, M., Canner, J. K., Gearhart, S. L., Safar, B., Fang, S. H., & Efron, J. E. (2018). Predicting the risk of readmission from dehydration after ileostomy formation: The Dehydration Readmission After Ileostomy Prediction score. Diseases of the Colon & Rectum, 61(12), 1410–1417. https://doi.org/10.1097/DCR.0000000000001217
  8. Culkin, A., Gabe, S. M., & Nightingale, J. M. D. (2022). A new palatable oral rehydration solution: A randomised controlled cross-over study in patients with a high output stoma. Journal of Human Nutrition and Dietetics, 35(1), 94–101. https://doi.org/10.1111/jhn.12935
  9. Gupta, A., Gupta, E., Hilsden, R., Hawel, J. D., Elnahas, A. I., Schlachta, C. M., & Alkhamesi, N. A. (2021). Preoperative malnutrition in patients with colorectal cancer. Canadian Journal of Surgery, 64(6), E621–E629. https://doi.org/10.1503/cjs.016820
  11. Gustafsson, U. O., Rockall, T. A., Wexner, S., How, K. Y., Emile, S., Marchuk, A., Fawcett, W. J., Sioson, M., Riedel, B., Chahal, R., Balfour, A., Baldini, G., de Groof, E. J., Romagnoli, S., Coca-Martinez, M., Grass, F., Brindle, M., & Hubner, M. (2025). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025. Surgery, 184, 109397. https://doi.org/10.1016/j.surg.2025.109397
  13. Hoeg, A. J., Jaques, J., Johnson, R., Kocher, M., Weingarden, A., Vaughn, B., Khoruts, A., Jahansouz, C., Hurt, R. T., & Teigen, L. M. (2026). Oral rehydration solution for the management of fluid and electrolyte disturbances in patients with an ileostomy: A scoping review. Journal of Parenteral and Enteral Nutrition, 50(3), 339–351. https://doi.org/10.1002/jpen.70050
  15. Justiniano, C. F., Temple, L. K., Swanger, A. A., Xu, Z., Speranza, J. R., Cellini, C., Salloum, R. M., & Fleming, F. J. (2018). Readmissions with dehydration after ileostomy creation: Rethinking risk factors. Diseases of the Colon & Rectum, 61(11), 1297–1305. https://doi.org/10.1097/DCR.0000000000001137
  17. Kiela, P. R., & Ghishan, F. K. (2016). Physiology of intestinal absorption and secretion. Best Practice & Research Clinical Gastroenterology, 30(2), 145–159. https://doi.org/10.1016/j.bpg.2016.02.007
  19. Lee, N., Lee, S. Y., Kim, C. H., Kwak, H. D., Ju, J. K., & Kim, H. R. (2021). The relationship between high-output stomas, postoperative ileus, and readmission after rectal cancer surgery with diverting ileostomy. Annals of Coloproctology, 37(1), 44–50. https://doi.org/10.3393/ac.2020.08.03
  21. Ma, H., Li, X., Yang, H., Qiu, Y., & Xiao, W. (2022). The pathology and physiology of ileostomy. Frontiers in Nutrition, 9, 842198. https://doi.org/10.3389/fnut.2022.842198
  23. Michońska, I., Polak-Szczybyło, E., Sokal, A., Jarmakiewicz-Czaja, S., Stępień, A. E., & Dereń, K. (2023). Nutritional issues faced by patients with intestinal stoma: A narrative review. Journal of Clinical Medicine, 12(2), 510. https://doi.org/10.3390/jcm12020510
  25. Mitchell, A., England, C., Perry, R., Lander, T., Shingler, E., Searle, A., & Atkinson, C. (2021). Dietary management for people with an ileostomy: A scoping review. JBI Evidence Synthesis, 19(9), 2188–2306. https://doi.org/10.11124/JBIES-20-00377
  27. Moreno Santamaría, M., Arenas Villafranca, J. J., Abilés, J., Rivas Ruiz, F., Utrilla Navarro, P., & Tortajada Goitia, B. (2021). Impact of a nutrition consultation on the rate of high output stoma-related readmission: An ambispective cohort study. Scientific Reports, 11(1), 16620. https://doi.org/10.1038/s41598-021-96136-7
  29. Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T. S., Strasser, F., … Bischoff, S. C. (2021). ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition, 40(5), 2898–2913. https://doi.org/10.1016/j.clnu.2021.02.005
  31. Negussie, A. B., Dell, A. C., Davis, B. A., & Geibel, J. P. (2022). Colonic fluid and electrolyte transport 2022: An update. Cells, 11(10), 1712. https://doi.org/10.3390/cells11101712
  33. Nightingale, J. M. D. (2022). How to manage a high-output stoma. Frontline Gastroenterology, 13(2), 140–151. https://doi.org/10.1136/flgastro-2018-101108
  34. Ozata, I. H., Tufekci, T., Aksan, T., Eren, E., Karahan, S. N., Kalender, M., Gulluoglu, Y. B., Uymaz, D. S., Ozoran, E., Karadag, A., Rencuzogullari, A., Bugra, D., & Balik, E. (2024). Reducing dehydration-induced readmissions post-colorectal surgery: The impact of a prevention bundle. International Journal of Colorectal Disease, 39(1), 138. https://doi.org/10.1007/s00384-024-04709-5
  36. Parini, D., Bondurri, A., Ferrara, F., Rizzo, G., Pata, F., Veltri, M., Forni, C., Coccolini, F., Biffl, W. L., Sartelli, M., Kluger, Y., Ansaloni, L., Moore, E., Catena, F., & Danelli, P. (2023). Surgical management of ostomy complications: A MISSTO–WSES mapping review. World Journal of Emergency Surgery, 18(1), 48. https://doi.org/10.1186/s13017-023-00516-5
  38. Pedersen, A. K. N., Rud, C., Wilkens, T. L., Borre, M., Andersen, J. R., Dahlerup, J. F., & Hvas, C. L. (2020). A single urine sodium measurement may validly estimate 24-hour urine sodium excretion in patients with an ileostomy. Journal of Parenteral and Enteral Nutrition, 44(2), 246–255. https://doi.org/10.1002/jpen.1593
  40. Quist, J. R., Rud, C. L., Frumer, K., Julsgaard, M., Dahl Baunwall, S. M., & Hvas, C. L. (2024). Osmolality in oral supplements drives ileostomy output: Defining the Goldilocks zone. Clinical Nutrition ESPEN, 61, 88–93. https://doi.org/10.1016/j.clnesp.2024.03.003
  42. Retnoningrum, D., & Dahlia, D. (2024). Pemberian edukasi berbasis multimedia terhadap kemampuan perawatan diri pasien kanker kolorectal dengan stoma. Journal of Telenursing (JOTING), 6(1), 1407–1414. https://doi.org/10.31539/joting.v6i1.9431
  44. Rud, C. L., Brantlov, S., Quist, J. R., Wilkens, T. L., Dahlerup, J. F., Lal, S., Jeppesen, P. B., & Hvas, C. L. (2023). Sodium depletion and secondary hyperaldosteronism in outpatients with an ileostomy: A cross-sectional study. Scandinavian Journal of Gastroenterology, 58(9), 971–979. https://doi.org/10.1080/00365521.2023.2200440
  45. Rud, C. L., Hvistendahl, M. K., Langdahl, B., Kraglund, F., Dahl Baunwall, S. M., Lal, S., Jeppesen, P. B., & Hvas, C. L. (2024). Protein-based oral rehydration solutions for patients with an ileostomy: A randomised, double-blinded crossover study. Clinical Nutrition, 43(7), 1747–1758. https://doi.org/10.1016/j.clnu.2024.05.038
  47. Santucci, N. R., & Velez, A. (2024). Physiology of lower gastrointestinal tract. Alimentary Pharmacology & Therapeutics, 60(S1), S1–S19. https://doi.org/10.1111/apt.17900
  48. Solitano, V., Vuyyuru, S. K., Yuan, Y., Singh, S., Narula, N., Ma, C., Hanzel, J., Hutton, M., Van Koughnett, J. A., Rieder, F., & Jairath, V. (2024). Management of complications in patients with an ileostomy: An umbrella review of systematic reviews for the EndOTrial Consortium. International Journal of Colorectal Disease, 39(1), 147. https://doi.org/10.1007/s00384-024-04714-8
  49. Takeda, M., Takahashi, H., Haraguchi, N., Miyoshi, N., Hata, T., Yamamoto, H., Matsuda, C., Mizushima, T., Doki, Y., & Mori, M. (2019). Factors predictive of high-output ileostomy: A retrospective single-center comparative study. Surgery Today, 49(6), 482–487. https://doi.org/10.1007/s00595-018-1756-2
  51. van Loon, Y. T., Poylin, V. Y., Nagle, D., & Zimmerman, D. D. E. (2020). Effectiveness of the ileostomy pathway in reducing readmissions for dehydration: Does it stand the test of time? Diseases of the Colon & Rectum, 63(8), 1151–1155. https://doi.org/10.1097/DCR.0000000000001627
  53. Vogel, I., Shinkwin, M., van der Storm, S. L., Torkington, J., Cornish, J. A., Tanis, P. J., Hompes, R., & Bemelman, W. A. (2022). Overall readmissions and readmissions related to dehydration after creation of an ileostomy: A systematic review and meta-analysis. Techniques in Coloproctology, 26(5), 333–349. https://doi.org/10.1007/s10151-022-02580-6
  55. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., Laviano, A., Ljungqvist, O., Lobo, D. N., Martindale, R. G., Waitzberg, D., Bischoff, S. C., & Singer, P. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745–4761. https://doi.org/10.1016/j.clnu.2021.03.031
  57. Wyer, N. (2022). Dietary management of patients with a high-output stoma. Nursing Standard, 37(4), 71–76. https://doi.org/10.7748/ns.2022.e11941
  58. Yang, S., Tang, G., Zhang, Y., Wei, Z., & Du, D. (2024). Meta-analysis: Loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer. International Journal of Colorectal Disease, 39(1), 68. https://doi.org/10.1007/s00384-024-04639-2

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