Are you getting enough hydration? (How to make St. Mark’s solution)

If you have a J Pouch, it is important to ensure that you are getting adequate and appropriate hydration. For many years, St. Mark’s has recommended a particular formulation for pouchees and ostomates. In this article we explain how to make the St. Mark’s hydration solution.

(Updated 28 December 2022)

St. Mark’s solution is a potassium-free glucose electrolyte mix commonly referred to as an oral rehydration solution (ORS). It is used for the management of short bowel syndrome caused by surgical removal or congenital disease of the small intestine. St. Mark’s solution may be recommended by your doctor or dietitian if you have a high pouch output.

Due to this complex condition you may not be able to absorb enough water, vitamins, minerals, protein, fat, calories and other nutrients from food whilst on a normal diet. If you are not absorbing enough fluid you may experience a high output from your stoma.

If your output is high and you are losing more than 1500mL per day from your pouch, you are at a greater risk of becoming dehydrated. To prevent dehydration you may be advised to drink 1 to 3 litres of ORS solution, sipped throughout the day. 

How to make St. Mark’s solution 

All ingredients for St. Mark’s solution can be bought from supermarkets or pharmacies for less than a single prescription charge.  The ingredients need to be dissolved in 1 litre of cold tap water  The prescribed amount should be sipped throughout the day The solution must be thrown away within 24 hours and a fresh solution should be prepared the following day . The solution may taste salty but can be improved by: 

• being stored in the fridge before you drink it, so it is chilled  being frozen and taken as slush ,
• being sipped through a straw ,
• adding a small amount of squash, fruit juice or cordial.

These adjustments are best added while making up the solution rather than adding to each glass, to ensure the salt content remains high

Ingredients for 1 litre batch:

• Glucose powder (20g – 6 teaspoons)
• Table salt (sodium chloride) 3.5g – 1 level 5ml. tea spoon
• Sodium bicarbonate or sodium citrate 2.5g – heaped 2.5ml teaspoon 

Managing your pouch output

Drinking too much ordinary fluid will increase your pouch output and make you dehydrated. When it is hot, we sweat and lose salt and fluid from the body. In this situation people with a high pouch output are more likely to get dehydrated and you may find you need to drink more electrolyte mix to replace these losses.

Speak to your doctor or dietitian for advice on increasing the amount of daily St. Mark’s solution you are drinking.

You can reduce your pouch output by:

• Limiting the amount of ordinary fluids that you drink (for example fruit juice, squash, fizzy drinks, water, tea, coffee) to about 1 litre (about 6 cups per day)
• Drinking a rehydration solution like St. Mark’s solution electrolyte mix to help your body absorb fluid and salt
• Increasing your salt intake
• Reducing your fibre intake

If you need more information, please talk to your doctor, specialist nurse or pharmacist.