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, anα
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 North-western 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 mL/d (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.
Transdermal clonidine results in a modest decrease in fluid and sodium losses in jejunostomy patients.
