Osmolality in oral supplements drives ileostomy output: defining the Goldilocks zone

Background 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 increases sodium loss. We hypothesized the existence of an osmolality range in which fluid absorption and secondary natriuresis are optimal. Methods 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 3 to 18 different oral supplements and a standardized meal during the various 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 ileostomy patients with a median age of 65 years (interquartile range 38–70 years) were included. The association between osmolalities (range 5–1,352 mOsm/kg) and ileostomy output forecasted an S-curve. A linear association between osmolality of oral supplements (range 290-600 mOsm/kg) and ileostomy output was identified and assessed with a mixed-effects model. Ileostomy output increased by 57 g/6 hours (95% confidence interval (CI) 21–94) when the oral supplement osmolality increased by 100 mOsm/kg (p=0.005). Conclusion Osmolality in oral supplements correlated with ileostomy output. Our results indicate that patients with an ileostomy may benefit from increased ingestion of oral supplements with osmolalities between 100 and 290 mOsm/kg. We define this range as the Goldilocks zone, equivalent to optimal fluid and electrolyte absorption.