56 Acute Diarrhea
BUY
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9. Special Medications:
-Ranitidine (Zantac) 12.5 mg/h (300 mg in 250 mL D5W at 11 mL/h) IV or 50
mg IV q6-8h OR
Cimetidine (Tagamet) 100 mg/h IV or 300 mg IV q8h OR
Famotidine (Pepcid) 20 mg IV q12h.
-Ticarcillin/clavulanate (Timentin) 3.1 gm IV or ampicillin/sulbactam (Unasyn)
3.0 gm IV q6h or imipenem (Primaxin) 0.5-1.0 gm IV q6h.
-Antibiotics are indicated for infected pancreatic pseudocysts or for abscess
only. Uncomplicated pancreatitis does not require antibiotics.
-Heparin 5000 U SQ q12h.
-Total parenteral nutrition should be provided until the amylase and lipase are
normal and symptoms have resolved.
10. Symptomatic Medications:
-Meperidine 50-100 mg IM/IV q3-4h prn pain.
11. Extras: Upright abdomen, portable CXR, ECG, ultrasound, CT with contrast.
Surgery and GI consults.
12. Labs: CBC, platelets, SMA 7&12, calcium, triglycerides, amylase, lipase,
LDH, AST, ALT; blood C&S x 2, hepatitis B surface antigen, INR/PTT, type and
hold 4-6 U PRBC and 2-4 U FFP. Pancreatic isoamylase, UA.
Acute Diarrhea
1. Admit to:
2. Diagnosis: Acute Diarrhea
3. Condition:
4. Vital signs: q6h; call physician if BP >160/90, <80/60; P >120; R>25; T
>38.5
C
5. Activity: Up ad lib
6. Nursing: Daily weights, inputs and outputs.
7. Diet: NPO except ice chips for 24h, then low residual elemental diet; no milk
products.
8. IV Fluids: 1-2 L NS over 1-2 hours; then D5 1 NS with 40 mEq KCL/L at 125
cc/h.
9. Special Medications:
Febrile or gross blood in stool or neutrophils on microscopic exam or prior
travel:
-Ciprofloxacin (Cipro) 500 mg PO bid OR
-Norfloxacin (Noroxin) 400 mg PO bid OR
-Ofloxacin (Floxin) 300 mg bid OR
-Trimethoprim/SMX (Bactrim DS) (160/800 mg) one DS tab PO bid.
11. Extras: Upright abdomen. GI consult.
12. Labs: SMA7 and 12, CBC with differential, UA, blood culture x 2.
Stool studies: Wright's stain for fecal leukocytes, ova and parasites x 3, clos-
tridium difficile toxin, culture for enteric pathogens, E coli 0157:H7 culture.
