Resulting condition from short bowel syndrome

[Theoldguy]

  In 1994 at the age of 51  my wife had 11 feet of small intestine and a 1 foot section of the large (colon) removed along with a colostomy, ileostomy (both reversed) and a hysterectomy.
Over the past 14 years her body has recovered quite well considering.
She has a consistent problem of mal-absorption, oily stool and diarrhea five to eight times daily, attributed to the short bowel syndrome. She is drinking plenty of water daily (about 1/2 gal) to keep hydrated, but is probably still dehydrated.
She has gained 18 lbs of the weight she lost after the surgeries.
She has a continuing problem with severe leg cramps and a weakness in the lower extremities.
We know that her absorption rate of important electrolyte, minerals (magnesium and calcium etc) are probably lower than they should be.
She also has chronic kidney failure resulting in an out of range fluctuation of the bun (36 to 42) and creatinine (2.2 to 3.2) serum readings. Her urine is foamy most of the time.
What lab test should we ask our doctor for so that we can determine the root of her problems (severe leg cramps)?  In our research we have learned that true magnesium levels (in the blood) are not always a true picture of what is in the tissue.  What amount of vitamin D, calcium and magnesium would you suggest as a daily supplement?
We realize that this is unchartered territory as there not too many folks still alive after having 12 feet of intestine removed. Any suggestions on diet, or supplements would also be greatly appreciated.

Thank you
Theoldguy

[boron]

Regarding that the ileocecal valve (between ileum and colon) was removed, it is possible that colonic bacteria have colonised the small intestine (small intestinal bacterial overgrowth). Remind the doctor of this possibility, since this is often overlooked.

[boron]

Leg cramps and weakness are characteristic in hypokalemia. So serum potassium has to be checked (all other electrolytes will be checked at the same time routinely).

Eventual vitamine supplements should be prescribed on a basis of vitamin levels in the blood. Fat soluble vitamins (A,D,E,K) are probably malabsorbed, since fat is obviously malabsorbed. In ileum removal (as in your wife case) folate and vit B12 are usually malabsorbed.

Foamy urine is probably due to excess protein excretion in urine (kidney failure).

If she can't be hydrated properly with the plain water, then she should take some salt and sugar with the fluid, what greatly improves water absorption. There are many possibilities: sport drink, like Gatorade, rehydration solutions like Pedialyte, Rehydralyte...or the solution may be prepared at home.

Do not in any case try with any supplements without prior doctor's evaluation.

She needs:
1. Serum electrolytes, urea, proteins check.
2. Replacment of electrolytes, proteins, vitamins, water...as decided by a doctor.

Hypokalemia may be life dangerous, it may cause arrhythmia, so I suggest prompt visit of a doctor.