Editing Intestinal Segments and Urinary Diversion (section)

==== <span style="color:#0000ff">L</span><span style="color:#ff0000">ytes ====
* '''Factors that influence the amount of solute and type of absorption are:'''
*# '''Segment of bowel used'''
*# '''Surface area of the bowel'''
*# '''Amount of time the urine is exposed to the bowel'''
*# '''Concentration of solutes in the urine'''
*# '''Renal function'''
*# '''pH of the fluid'''

INSERT TABLE

*'''Stomach conduit'''
** '''Electrolyte imbalances rarely occur in patients with normal renal function. However, hypochloremic, hypokalemic metabolic alkalosis''' '''can occur in patients with concomitant renal failure.'''
*** Symptoms of this include lethargy, respiratory insufficiency, seizures, and ventricular arrhythmias may occur.
*** '''Patients are usually successfully treated with an H2 blocker to reduce proton secretion by the gastric segment and rehydration.'''
* '''Jejunal conduit'''
** '''Hypochloremic, hyperkalemic, hyponatremic metabolic acidosis can occur.''' 
*** Symptoms of this include lethargy, nausea, vomiting, dehydration, muscle weakness, and elevated temperature.
*** '''May be exacerbated by administration of hyperalimentation solutions'''.
*** The severity of the syndrome depends on the location of the segment of jejunum that is used. The more proximal the segment, the more likely the syndrome is to develop.
*** '''Treatment is rehydration with sodium chloride and correction of the acidosis with sodium bicarbonate'''.
**** Provided that renal function is normal, the hyperkalemia is corrected by renal secretion.
**** '''A thiazide diuretic may be helpful to correct the hyperkalemia''' '''(recall side effects of thiazides: 3 hypers and 3 hypos: hyperglycemia, hyperlipidemia, and hyperuricemia with hypokalemia, hypocitraturia, and hypomagnesuria with metabolic alkalosis).'''
**** After restoration of normal electrolyte balance, long-term therapy involves oral supplements with sodium chloride and a thiazide diuretic, if needed.
* '''Ileum or colon conduit'''
** '''Hyperchloremic metabolic acidosis can occur.'''
*** Symptoms of this include lethargy, easy fatigability, anorexia, weight loss, and polydipsia.
*** '''The mechanism of hyperchloremic metabolic acidosis is a result of the ionized transport of ammonium'''
** '''Treatment involves alkalizing agents or blockers of chloride transport.'''
*** '''≈16% of patients with ileal conduits will develop metabolic acidosis requiring treatment.'''
*** '''Alkalinization with oral sodium bicarbonate is effective in restoring normal acid-base balance.'''
*** '''Potassium citrate, sodium citrate, and citric acid solution (Polycitra) may be used instead if excessive sodium administration is a problem because of cardiac or renal disease and if potassium supplementation is desirable or at least not harmful.'''
* '''Hypokalemia and total-body depletion of potassium may occur''' in patients with urinary intestinal diversion [though hyperkalemia with jejunal conduit].
** '''More common in patients with ureterosigmoidostomies'''
** '''In treating these patients, if the hypokalemia is associated with severe hyperchloremic metabolic acidosis, treatment must involve both replacement of potassium and correction of the acidosis with bicarbonate'''