Sodium Conservation after Total or Snb—Total Colonie Resection in Children*

Abstract

Ricour, C., Millot, M. & Balsan, S. Sodium conservation after total or sub-total colonic resection in children. Scand. J. Gastroent. 1973, 8, 743-750.

Volume of stools, and urine, fecal and urinary excretion of sodium, and potassium and urinary excretion of tetrahydroaldosterone were analyzed in 8 children with ileostomies or colostomies. The study was performed using balance techniques. The sole variable was a stepwise reduction of sodium intake, every 6 days. 1) In the absence of the colon, adaptation of the small intestine to sodium restriction was manifested by a decrease in mean fecal sodium concentration and excretion. This phenomenon occurred against a concentration gradient rising from 10 to 80 mEq/1. It seems likely that this enhanced sodium transport was accompanied by a water flux, indirectly demonstrated by reduction of stool volume and by a simultaneous increase of urine flow. During this process, the luminal content remained iso-osmotic because of a significant rise in fecal potassium concentration. A simultaneous rise in the urinary excretion of tetrahydroaldosterone suggests that aldosterone may play a part in the control of sodium conservation at the level of the small intestine. However, ileal conservation of sodium is quite limited, since symptoms of sodium depletion appear if the intake is reduced to 1 mEq/kg/24 hours. 2) When a colonic segment is preserved, sodium balance remained normal even when intake was reduced to 0.3 mEq/kg/24 hours over 6 days. The prevention of fluid and electrolyte depletion in children without a functional colon can be avoided provided a few rules are followed. Survey of such patients should include weight measurement, serum sodium concentration, and 24-hour urinary sodium excretion. In the experience of the authors, a water intake of 150 to 250 ml/kg/24 hours and a sodium intake of 6 to 10 mEq/kg/24 hours permit satisfactory electrolyte balance without secondary hyperaldosteronism.

Key-words::

• Children
• colectomy
• colon
• electrolytes