Strategies for Managing Fluids and Electrolytes in High-Output Stomas: A Systematic Review and Evidence Summary

Anna Wen,1,* Yanxia Jiao,2,* Ning Wang,2 Jie Xu,1 Xinyue Xu,1 Li Du,1 Lin Lv3 1Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, People’s Republic of China; 2Wound and Ostomy Care Center, Outpatient Department, Gansu Provincial Hospital, Lanzhou, Gansu, People’s Republic of China; 3Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Wound and Ostomy Care Center, Outpatient Department, Gansu Provincial Hospital, NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Lanzhou, Gansu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lin Lv, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Wound and Ostomy Care Center, Outpatient Department, Gansu Provincial Hospital, NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, #28 Yanxi Road, Chenguan District, Lanzhou, Gansu, People’s Republic of China, Email [email protected]: This study aimed to explore intervention strategies for fluid and electrolyte regulation in patients with high-output stomas, to optimize their clinical outcomes and quality of life.Results: Fifteen experimental and semi-experimental studies were systematically reviewed. Interventions were categorized into five types by therapeutic purpose and route: gastrointestinal motility/anti-secretory agents, Glucagon-like Peptide-1/2 (GLP-1/2) analogs, rehydration/electrolyte supplements, micronutrient supplements, and dietary restriction. Key HOS complications included hyponatremia, hypomagnesemia, metabolic acidosis, hypokalemia, hypocalcemia, and kidney injury.Conclusion: Hydro-electrolyte management in patients with HOS requires a multidisciplinary approach that integrates fluid management, pharmacotherapy, nutritional support, and surgical intervention. This framework may reduce dehydration-related readmission and improve outcomes. Future large-scale prospective studies are warranted to verify the efficacy, safety, and novel therapies, explore new therapeutic targets/drugs, and develop standardized guidelines, with an emphasis on individualized management for complex cases and prioritizing patient quality of life.Keywords: dehydration prevention, hyponatremia, hypomagnesemia, pharmacotherapy, multidisciplinary team