Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy: A controlled study

Alan L. Buchman, Jon Fryer, Anita Wallin, Chul W. Ahn, Sharon Polensky, Karen Zaremba

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an α 2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9 ± 10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that ended in a jejunostomy, were studied. Methods: Subjects were admitted to the Northwestern General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427 ± 562 mlVd (8.9%, p = .07). Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine volume correspondingly increased by 747 ± 1934 mL (18.9%, p = not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r = -0.37 and -0.41, respectively,p = NS). Oral fluid intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203 ± 1.119 L/d with clonidine therapy (-3.8%, p = NS). Fecal Na loss was significantly decreased from baseline (887 ± 996 mg/d, 11.2 ± 12.3%; p = .036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799 ± 2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy (p = NS). No patient developed hypotension. Conclusions: Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.

Original languageEnglish (US)
Pages (from-to)487-491
Number of pages5
JournalJournal of Parenteral and Enteral Nutrition
Volume30
Issue number6
DOIs
StatePublished - 2006

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clonidine
Jejunostomy
Clonidine
Diarrhea
diarrhea
Sodium
sodium
urine
Short Bowel Syndrome
Weights and Measures
Fats
mouth
Urine
Magnesium
Potassium
Nitrogen
Parenteral Infusions
Rehydration Solutions
magnesium
Cutaneous Administration

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Food Science

Cite this

Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy : A controlled study. / Buchman, Alan L.; Fryer, Jon; Wallin, Anita; Ahn, Chul W.; Polensky, Sharon; Zaremba, Karen.

In: Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 6, 2006, p. 487-491.

Research output: Contribution to journalArticle

Buchman, Alan L. ; Fryer, Jon ; Wallin, Anita ; Ahn, Chul W. ; Polensky, Sharon ; Zaremba, Karen. / Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy : A controlled study. In: Journal of Parenteral and Enteral Nutrition. 2006 ; Vol. 30, No. 6. pp. 487-491.
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abstract = "Background: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an α 2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9 ± 10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that ended in a jejunostomy, were studied. Methods: Subjects were admitted to the Northwestern General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net {"}secretors{"} in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427 ± 562 mlVd (8.9{\%}, p = .07). Fecal weight decreased by 438 ± 527 g/d (9.4{\%}, p = .05). Urine volume correspondingly increased by 747 ± 1934 mL (18.9{\%}, p = not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r = -0.37 and -0.41, respectively,p = NS). Oral fluid intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203 ± 1.119 L/d with clonidine therapy (-3.8{\%}, p = NS). Fecal Na loss was significantly decreased from baseline (887 ± 996 mg/d, 11.2 ± 12.3{\%}; p = .036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799 ± 2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy (p = NS). No patient developed hypotension. Conclusions: Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.",
author = "Buchman, {Alan L.} and Jon Fryer and Anita Wallin and Ahn, {Chul W.} and Sharon Polensky and Karen Zaremba",
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T1 - Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy

T2 - A controlled study

AU - Buchman, Alan L.

AU - Fryer, Jon

AU - Wallin, Anita

AU - Ahn, Chul W.

AU - Polensky, Sharon

AU - Zaremba, Karen

PY - 2006

Y1 - 2006

N2 - Background: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an α 2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9 ± 10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that ended in a jejunostomy, were studied. Methods: Subjects were admitted to the Northwestern General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427 ± 562 mlVd (8.9%, p = .07). Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine volume correspondingly increased by 747 ± 1934 mL (18.9%, p = not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r = -0.37 and -0.41, respectively,p = NS). Oral fluid intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203 ± 1.119 L/d with clonidine therapy (-3.8%, p = NS). Fecal Na loss was significantly decreased from baseline (887 ± 996 mg/d, 11.2 ± 12.3%; p = .036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799 ± 2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy (p = NS). No patient developed hypotension. Conclusions: Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.

AB - Background: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an α 2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9 ± 10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that ended in a jejunostomy, were studied. Methods: Subjects were admitted to the Northwestern General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427 ± 562 mlVd (8.9%, p = .07). Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine volume correspondingly increased by 747 ± 1934 mL (18.9%, p = not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r = -0.37 and -0.41, respectively,p = NS). Oral fluid intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203 ± 1.119 L/d with clonidine therapy (-3.8%, p = NS). Fecal Na loss was significantly decreased from baseline (887 ± 996 mg/d, 11.2 ± 12.3%; p = .036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799 ± 2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy (p = NS). No patient developed hypotension. Conclusions: Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.

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