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

Purpose: 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.