Five children with ileostomies established in the neonatal period and modified Soave ileo-endorectal pull-throughs done at 7-14 mo of age have been followed. Episodes of salt and water depletion occurred both pre- and post-pull-through. Following the Soave procedures, all patients experienced recurrent episodes of abdominal distention with diarrhea, hypovolemia, and hyponatremia. Treatment included oral and intravenous sodium supplementation, as required. Sodium balance studies done (in three of the five) when the children were 5-9 yr of age suggested that although they appear well, the patients are in tenuous sodium balance. One hundred meq of dietary sodium were provided for 7 days followed by 7 meq sodium/day for 5 days. The children tolerated the sodium restriction poorly in spite of maximal renal sodium conservation. The response of the gastrointestinal tract to sodium restriction was a reduction of mean daily sodium output from 55 meq to 17 meq. This limited adaptation, which was not observed until the third day of restriction, was inadequate. The children lost weight and developed the signs and symptoms of salt and water depletion. Presumably renal and gastrointestinal sodium conservation was a response to circulating aldosterone which rose to levels 15-90 times those observed in normal children.
- Total colectomy
- salt depletion
- water depletion
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health