Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Escalate
Rigors, fever, hypotension or confusion during or after a parenteral infusion requires emergency sepsis assessment, appropriately timed paired line and peripheral cultures and immediate intestinal-failure or infection-team contact. High stoma output with oliguria, postural symptoms, rising creatinine or severe electrolyte disturbance requires urgent fluid and sodium replacement with specialist review.
Synopsis
Relate remaining bowel anatomy to fluid and nutrient loss, manage a high-output stoma without worsening sodium depletion, recognise line sepsis and intestinal-failure liver disease, and coordinate home parenteral support or teduglutide through a specialist centre.
Intestinal failure means gut function is insufficient to absorb macronutrients, water or electrolytes so intravenous supplementation is needed; short bowel is one anatomical cause.
Record the length and segment of remaining small bowel, whether colon is in continuity, ileocaecal valve, stoma and fistulae because these predict fluid and nutritional behaviour.
A jejunostomy with high output loses sodium-rich fluid; drinking large volumes of plain water or hypotonic drink can increase net sodium and water loss.
Key red flags
High-output stoma dehydration
Output commonly above 1.5 to 2 litres daily with thirst, dizziness, low urine, cramps, weight loss, rising urea or creatinine and hypomagnesaemia suggests net intestinal fluid loss.
Investigation priorities
01
Anatomical reconstructionFirst step
Retrieve operative records and contrast or cross-sectional imaging to document residual jejunum and ileum, colon continuity, valve, stoma, fistula and strictures.
Management branches
OutputHigh-output jejunostomy
Stoma output rises with thirst, falling urine, weight loss or biochemical depletion.
Exclude obstruction, infection, recurrent disease and medicine withdrawal, then measure 24-hour oral intake, output, urine and weight.
Replace intravenous sodium and magnesium when clinically depleted, and use the specialist high-sodium oral rehydration plan while limiting hypotonic fluid.
ChronicReduce parenteral dependence safely
Chronic short-bowel intestinal failure is clinically stable on an optimised regimen.
Key medicines
High-dose loperamideSpecialist doses given 30 to 60 minutes before meals and at night may exceed routine licensed limits in intestinal failure; follow the current BIFA ECG and prescribing guidance.
Proton pump inhibitorA current BNF oral or intravenous regimen selected for early gastric hypersecretion, absorption and ongoing output, then reviewed for continued need.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.