Therapeutic Handbook - GGC Prescribing

Management of Severe Exacerbation ofInflammatory Bowel DiseaseAssessment / monitoringGastrointestinal SystemOn admission• Stool culture and Clostridium difficile toxin.• Stool chart (kept by nursing staff).• BP / pulse / temperature – frequency depends on initial findings.• Bloods – FBC; CRP or ESR; U&Es; LFTs; blood cultures.• X-ray – plain film of abdomen.• If features suggesting severe disease present, seek immediate senior review.• Unprepared sigmoidoscopy in new patient.General management and treatment options• Avoid anti-diarrhoeal agents• Give IV fluids• Give hydrocortisone sodium succinate IV infusion 100 mg every 6 hours ormethylprednisolone 30 mg IV infusion every 12 hours. Check which drug is used onyour site before prescribing.• Give low residue diet / oral fluids• Give high calorie supplements• If Hb < 90 g/L – transfuse• High risk of venous thromboembolism – give thromboprophylaxis (unless contraindicated):enoxaparin SC 40 mg once daily (20 mg once daily if eGFR < 30 ml/minute /1.73m 2as these patients are at risk of DVT.• Involve gastroenterologist / gastrointestinal surgeon.Note: Caution with:• NarcoticsPatient with abdominal pain mustbe seen and assessed before• Antispasmodics prescribing analgesia.• Hypokalaemia• Barium enemaDiscuss with radiologist / gastroenterologist.Continues on next pagePage 54