44 Diverticulitis
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Fungal Peritonitis:
-Amphotericin B peritoneal dialysis, 2 mg/L of dialysis fluid over the first 24
hours, then 1.5 mg in each liter OR
-Fluconazole (Diflucan) 200 mg IV x 1, then 100 mg IV qd.
10. Symptomatic Medications:
-Ranitidine (Zantac) 50 mg IV q8h.
-Acetaminophen (Tylenol) 325 mg PO/PR q4-6h prn temp >38.5
C.
-Heparin 5000 U SQ q12h.
11. Extras: Plain film, upright abdomen, lateral decubitus, CXR PA and LAT;
surgery consult; ECG, abdominal ultrasound. CT scan.
12. Labs: CBC with differential, SMA 7&12, amylase, lactate, INR/PTT, UA with
micro, C&S; drug levels peak and trough 3rd dose.
Paracentesis Tube 1: Cell count and differential (1-2 mL, EDTA purple top
tube)
Tube 2: Gram stain of sediment; inject 10-20 mL into anaerobic and aerobic
culture bottle; AFB, fungal C&S (3-4 mL).
Tube 3: Glucose, protein, albumin, LDH, triglycerides, specific gravity, bilirubin,
amylase (2-3 mL, red top tube).
Syringe: pH, lactate (3 mL).
Diverticulitis
1. Admit to:
2. Diagnosis: Diverticulitis
3. Condition:
4. Vital signs: qid. Call physician if BP systolic >160/90, <90/60; P >120, <50;
R>25, <10; T >38.5
C
5. Activity: Up ad lib.
6. Nursing: Inputs and outputs.
7. Diet: NPO. Advance to clear liquids as tolerated.
8. IV Fluids: 0.5-2 L NS over 1-2 hr then, D5 1 NS at 125 cc/hr. NG tube at low
intermittent suction (if obstructed).
9. Special Medications:
Regimen 1:
-Gentamicin or tobramycin 100-120 mg IV (1.5-2 mg/kg), then 80 mg IV q8h
(5 mg/kg/d) or 7 mg/kg in 50 mL of D5W over 60 min IV q24h AND EITHER
Cefoxitin (Mefoxin) 2 gm IV q6-8h OR
Clindamycin (Cleocin) 600-900 mg IV q8h.
Regimen 2:
-Metronidazole (Flagyl) 500 mg q8h AND
Ciprofloxacin (Cipro) 250-500 mg PO bid or 200-300 mg IV q12h.
Outpatient Regimen:
-Metronidazole (Flagyl) 500 mg PO q6h AND EITHER
Ciprofloxacin (Cipro) 500 mg PO bid OR
Trimethoprim/SMX (Bactrim) 1 DS tab PO bid.
