dehydration Archives - J Pouch support charity

St. Mark’s Oral Rehydration Solution (ORS)

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.

Stories

Your Internal pouch, dehydration and fragile skin

With our limited reservoirs for storing food and liquids, dehydration and dry skin are common problems for many pouchees. Acting treasurer Peter White reports

I always know the cold weather has arrived when my skin becomes more susceptible to injury. As many of us know, having an ileoanal pouch means losing out on some of the fluid absorption the large bowel or colon would normally perform. That means being prone to dehydration – and part of that condition is dry skin. For me, part of living without a colon means managing my skin.

So here are some of the key ways to deal with the problem:

Skin elasticity:

Cold and wet can make skin less elastic, and that has two impacts. First, it can split – leaving painful cracks which, sometimes do and sometimes don’t, result in minor bleeding; either way it hurts. Second, it leaves the hands more susceptible to damage, and this is the problem I really have to watch out for.

Cracking skin:

Avoiding cracking isn’t rocket science, but does require some attention. It’s quite common for women to carry moisturising hand cream, but not many men carry a handbag! Of course, there are relatively discreet ways to carry hand cream – in the car, in a work-bag, at your work desk and at home – and these cover most eventualities. In my experience women are also more than happy to share their hand cream with a man brave enough to ask!

Avoiding skin damage:

Avoiding skin damage takes more thought. For me gardening, DIY, water sports and mountaineering, each come with potential risks to the skin, and particularly the hands. Gloves are a really good way to manage these risks, and there are loads of different types available these days. For gardening and DIY leather gloves are well worth using. I recently took some skin off one of my knuckles trying to remove some wire mesh; it could have happened to anyone, but I suspect the injury was worse for me as my skin is less elastic than many people’s. For water sports I wear neoprene (wetsuit material) gloves summer and winter, which cost around £5 and absorb all the abrasion.

For mountaineering I often wear waterproof gloves and socks to reduce blisters and the effects of rubbing, and preventing the skin becoming saturated for prolonged periods. There are now a lot of waterproof gloves and some socks available for running, cycling, walking and other sports. If you can find them though, it’s well worth getting gloves which are smartphone compatible, especially in winter.

Repairing skin damage:

The body is of course extremely good at repairing itself. But constant wetness can hinder that process and result in unnecessary bleeding. With a pouch, going to the loo, and washing hands, are more frequent. So how do we keep hand injuries dry?

I have tried most varieties of plasters. Many are useless when wet. Even those that are waterproof are little use on moving parts (such as knuckles and other joints); inevitably they don’t stay on (or stay waterproof) for very long.

Something I use a lot is Germolene New Skin. Applied instead of a plaster on minor skin wounds, it’s basically like pasting UHU glue onto the injured part using a small spatula contained in the lid. Within a few minutes it has set, and a glue-like layer protects the skin from water (and infection). It can sting a bit, but it’s well worth it, as you can wash hands and have a shower without the inconvenience or discomfort associated with plasters or no covering. It’s my favourite plaster! I have even started using it for prevention on my feet, instead of taping them with micropore tape.

This article was first pucblished in Roar Issue 56 – Christmas 2018.

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