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

3 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.
Stool. Old blood. Necrotic material. Gastric juices. All of the above.

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

What are the electrolytes like with all that output?

Is the MD aware? If not, she/he should be.

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.

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.

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

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.......

Quote from LennonninjaWhat are the electrolytes like with all that output?

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.

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.