~9,000ml's/24 hours out of nasogastric tube

[noyesno]

I have a patient with a small bowel obstruction who's been outputting ~9,000 ml's every 24 hours from his nasogastric tube. This has been going on for three days. The tube is set to low intermittent suction and the output in dark brown.

Where is all this fluid coming from?

Isn't is bad to pull that much fluid out of someone?

Insight appreciated.

This is not HW. I am not in school. I'm a working woman.

[wooh, BSN, RN]

Even ice/water, it doesn't take much muck to make it dark brown. ESPECIALLY if tubing/canister hasn't been changed and instead has just been emptied.

[Been there,done that, ASN, RN]

What is the patient's history, current GI assessment , and vital signs?

[VivaLasViejas, ASN, RN]

Wow, I've never seen or heard of that sort of output from an NG before. How can this pt NOT be volume depleted, and is he receiving adequate IV fluids? Something really seems off about this whole case, starting with the MDs supposedly in charge of his care.

[suanna]

Like everyone else- I'd bet he is sipping somewhere- but as I see it- that isn't too big of a deal. I always encourage the docs to order sips and chips for patients with an NG. 1) I can control how much is going in- the patient is less likely to cheat if he is allowed some fluid, 2) up to about 100cc/hr this just helps keep the NG from clogging up- stomach goo can be pretty sticky. A sip or two an hour keeps everyone happier. 3) Even if he is sipping,- that is a LOT of output. You are right to ask for a daily BMP at least. It wouldn't hurt to check a daily/QOD venous PH when you draw the BMP- it's almost as useful as an ABG but with a lot less pain and risk to the patient.