The risk factors associated with a poor outcome in ischemic colitis include:

[ ]male sex,

[ ]hypotension (systolic blood pressure <90 mmHg),

[ ]tachycardia (heart rate >100 beats/minute),

[ ]abdominal pain without rectal bleeding,

[ ]blood urea nitrogen (BUN) >20 mg/dL,

[ ]hemoglobin (Hb) <12 g/dL,

[ ]lactate dehydrogenase (LDH) >350 units/L, (not collected)

[ ]serum sodium <136 mEq/L (mmol/L),

[ ] white blood cell count >15,000 cells/microliter.

> Since patient has <3 criteria this would be considered mild. (That doesn't preclude progression to moderate or severe).

Plan:

• Serial lactic acid checks.

• Serial abdominal exams to check for peritoneal signs.

• Avoid hypotension.

• Clear liquid diet and advance as tolerated.

• Add on LDH to help with risk stratification.

• Continue empiric Antimicrobial therapy given moderate disease

• Most cases of CI resolve spontaneously and do not require specific therapy.

• Patient will need follow up endoscopy

• Follow up pathology results.

• Ensure adequate colonic perfusion through intravenous fluids

• Treat any precipitating conditions and discontinue medications that promote intestinal ischemia (e.g., vasopressors, digitalis)

• Optimize cardiac function and oxygenation

• Most patients with non-occlusive colonic ischemia improve within one to two days and fully recover within one to two weeks

• Monitor for persistent fever, leukocytosis, peritoneal irritation, protracted diarrhea, or gastrointestinal bleeding

• If there is clinical deterioration despite conservative therapy, abdominal exploration is necessary. Surgical intervention should be considered in the presence of CI accompanied by hypotension, tachycardia, and abdominal pain without rectal bleeding. Will defer to surgery regarding such intervention based on his clinical course.

• Schedule follow up screening colonoscopy after this episode resolves.