Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages Lori R. Holtz, Marguerite A. Neill, Phillip I. Tarr  Gastroenterology  Volume 136, Issue 6, Pages 1887-1898 (May 2009) DOI: 10.1053/j.gastro.2009.02.059 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 Management flow chart for patients with bloody diarrhea. This flowchart suggests strategies for managing patients definitely or possibly infected with E coli O157:H7, in the context of the risk assigned by guidance in Table 4. BUN, blood urea nitrogen; CBC, complete blood count; IVF, intravenous fluid. Gastroenterology 2009 136, 1887-1898DOI: (10.1053/j.gastro.2009.02.059) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 Progression of E coli O157:H7 infections in children. Approximately 3 days after ingestion of the organism, the patient develops diarrhea, abdominal pain, fever, and vomiting. The diarrhea becomes bloody 1–3 days later, rarely on the first day. In 80%–90% of infected children with positive cultures, visible blood is present in the stools. When bloody diarrhea first develops, the patient has a normal platelet count, creatinine concentration, and packed-cell volume, with no red-cell fragmentation. However, if studies of the coagulation and fibrinolytic systems are done early in the illness, there is evidence that thrombin generation is increased, fibrin deposition is occurring, and plasminogen activation is suppressed.13 The platelet count is the first abnormality to appear and is used to monitor vascular injury in this disorder. Patients need to be monitored only until it is apparent that their platelet count is stable or rising (Table 3). Reprinted with permission from Lancet 2005;365:1073–1086. Gastroenterology 2009 136, 1887-1898DOI: (10.1053/j.gastro.2009.02.059) Copyright © 2009 AGA Institute Terms and Conditions

Lori R. Holtz Gastroenterology 2009 136, 1887-1898DOI: (10.1053/j.gastro.2009.02.059) Copyright © 2009 AGA Institute Terms and Conditions

Marguerite A. Neill Gastroenterology 2009 136, 1887-1898DOI: (10.1053/j.gastro.2009.02.059) Copyright © 2009 AGA Institute Terms and Conditions

Phillip I. Tarr Gastroenterology 2009 136, 1887-1898DOI: (10.1053/j.gastro.2009.02.059) Copyright © 2009 AGA Institute Terms and Conditions