5.  Total or segmental nonobstructive colonic dilatation  PLUS systemic toxicity  Most commonly transverse colon

6.  IBD  Infectious colitis C. diff Salmonella, shigella, campylobacter CMV Amoebic colitis  Ischemic colitis  Volvulus  Diverticulitis  Obstructive colon cancer

7.  Hypokalemia  Antimotility agents  Opiates  Anticholinergics  Antidepressants  Barium enema  Colonoscopy

8.  Toxic appearing  Altered sensorium  Hypotension/tachycardia  Fever  Abd distension and tenderness  +/- peritoneal signs

9.  Radiographic colonic distention  PLUS 3 of following Fever>38 Tachycardia Leukocytosis Anemia  PLUS at least 1 of the following Dehydration Altered sensorium Electrolyte disturbances Hypotension

10.  Goal: reduce severity of colitis Restore normal motility Decrease likelihood of perforation  Medical therapy is successful in preventing surgery in 50%  Surgical team should be consulted

11.  Complete bowel rest  NG tube  ICU monitoring  Serial abdominal exams  CBC, lytes, KUB q 12  Appropriate treatment if IBD present Steroids  Avoid steroids for infectious etiology

12.  Broad spectrum abx Third-generation cephalosporin Metronidazole  Discontinue Antimotility meds Opiates Anticholinergics  Generous IVF

13.  Perforation  No improvement in 3 days

14.  TPN if needed  Resume enteral feedings with first signs of improvement Mucosal healing Motility

15.  Stop offending agent  Vancomycin PO  Flagyl IV