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

Posted

Specializes in Family Medicine. Has 11 years experience.

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.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

Stool. Old blood. Necrotic material. Gastric juices. All of the above.

RunninOnCoffee

Specializes in ICU. Has 10 years experience.

One of my first thought- are you sure someone isn't giving the patient ice chips to suck on? Adding to the output?

Lennonninja, MSN, APRN, NP

Specializes in MICU - CCRN, IR, Vascular Surgery. Has 10 years experience.

What are the electrolytes like with all that output?

RNperdiem, RN

Has 14 years experience.

With all that stuff out, I hope your patient is at least feeling a little better. I would want fairly frequent labs to check electrolytes.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

9,000 mls? 9 liters? The gastric system and saliva are said to be about 4,000 - 5,000 mls /24 hours.

If the patient isn't showing signs of volume depletion...my vote it with someone is sneaking water.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

Someone is drinking! But geez- keeping up with emptying all of that.......

Mr. Murse

Specializes in critical care. Has 7 years experience.

Like others said.....my first thought was immediately that he's drinking or eating ice chips or something. I've never heard of that much output for that long of a time and we always have NG's on my floor. I'm wondering what his urine output is, and some of his lab work should be considered too. If everything else looks normal someone should probably start keeping a close watch on where he may be drinking from. I've known patients who were NPO and/or with NG's to go drink out of the faucets before. I mean that's 27 liters of fluid in the last 3 days!

Another possible consideration is mischarting.......

VANurse2010

Has 6 years experience.

What are the electrolytes like with all that output?

Really! That would be my concern. How is this patient not alkalotic?

noyesno, MSN, APRN, NP

Specializes in Family Medicine. Has 11 years experience.

Thanks for the replies one and all.

I'm glad I'm not the only one shocked by such a large output.

FLICURN, I was wondering if he was sneaking something but the output is dark brown. Maybe he's eating chocolates?

Lennonnija, the potassium was 2.6 yesterday. I cannot remember the other electrolytes off the top of my head.

jadelpn, the MD's managing his case suck. They are aware of the output and no one even ordered a chemistry panel on this patient yesterday. When they rounded, I was like, "***, can I please order a STAT CMP for this guy? Can I order one for tomorrow too?"

RNperdiem, he's feeling a little bit better but not great. Agreed, the MD's are barely keeping an eye on this patient. He didn't have labs ordered for two days and the nurses had to demand lab draws when they rounded.

Esme12, I agree. I think there may be some sneaking going on. He always keeps his room door open so I don't think he's sneaking anything there. Maybe, when he's in the bathroom?

meanmaryjean, yeah, we're emptying it like crazy. On day #1 of the NG, I was like, "okay, he just got the tube placed, it's going to drain a lot." On day #2 of the NG, I was thinking, "the output should be slowing soon." On day #3, I was like, "*** is going on here?"

Mr. Murse, yeah we better start watching him closely. I've been watching the canisters closely. The output is legit.

VANurse2010, I bet he is.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

Coffee? Coke?

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.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

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

Specializes in Post Anesthesia. Has 30 years experience.

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.