The British Intestinal Failure Alliance (BIFA)
Top Tips Article Series

During 2018, through In Touch, BIFA – a Specialist Interest Group of BAPEN – will be sharing a series of articles. Utilising the breadth of experience of the BIFA Committee, each article will deliver top tips on a variety of topics, providing you with practical, helpful advice to utilise in your day-to-day practice.

Managing a High Output Stoma or Fistula

Jeremy Nightingale and the BIFA Committee

A high output stoma (HOS) or fistula is when the output causes the patient to become water, sodium and magnesium depleted. This tends to occur when the output is more than 2 L/24 hours though this varies according to the amount of food/drink taken orally (if 4 litres/kg is consumed a 2 litre output may not be a problem but if only 0.5 litres/kg is consumed dehydration will follow). This occurs in 4-13% of small bowel stomas. It rarely occurs if there is more than half of the colon in continuity with the small intestine.

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