General management and treatment options
- Avoid anti-diarrhoeal agents
- Give IV fluids
- Give hydrocortisone sodium succinate IV infusion 100mg every 6 hours or methylprednisolone sodium succinate IV 30mg infusion every 12 hours. Check which drug is used on your site before prescribing.
- Give low residue diet / oral fluids.
- Give high calorie supplements
- If Hb below normal – replace deficient haematinics and consult with the gastroenterology team to advise on the need for transfusion or parenteral iron infusion.
- High risk of venous thromboembolism – give thromboprophylaxis (unless contraindicated):
enoxaparin SC 40mg once daily (20mg once daily if eGFR <30ml/min/1.73m2).
- Involve gastroenterologist / gastrointestinal surgeon
Note: Caution with:
- Barium enema
Discuss with radiologist / gastroenterologist.
*Patient with abdominal pain must be seen and assessed before prescribing analgesia.
- Monitor Hb, WCC, U&Es, CRP daily
- Daily abdominal film whilst on IV steroid therapy and arrange surgical review if transverse or ascending colon diameter >6cm.
- Light diet
- A CRP >45 or the stool frequency >8 at day 3 are bad prognostic signs and senior review and/or surgical review should be undertaken immediately.
Drug treatment after 5–7 days
- Change IV hydrocortisone to: prednisolone oral 40mg each day. Reduce no faster than by 5mg every 5–7 days. Normally there is gradual reduction over a 4–8 week period if CRP and stool frequency falling.
- If ulcerative colitis add mesalazine oral (seek specialist advice if unsure):
- Salofalk® MR granules 1.5-3g once daily or in three divided doses (or Salofalk® tablet 1.5-3g daily in three divided doses).
- Pentasa® MR tablets / sachets 2–4g once daily or
- Octasa® MR tablets 2.4-4.8g per day in divided doses
- Rectal preparations (e.g. mesalazine 1g suppositories / enemas) may be useful in proctitis, left sided disease and Crohn's disease of the rectum and anus. Seek specialist advice.
Normally discharged when:
- Stool frequency decreased, consistency increased and macroscopic blood decreased
- Lab parameters stable
- Follow-up OPD appointment made