E. Coli O157:H7


Pathophysiology

Diagnosis

Treatment

  1. Not specific/essentially supportive
  2. Hemorrhagic colitis or hemolytic anemia may require RBC transfusion
  3. See treatment of HUS

Disposition

  1. Report to Department of Public Health
  2. Children and adults with bloody diarrhea need close f/u
  3. Observation at hospital may be warranted
  4. Children w/ HUS usually warrant admission to tertiary hospital

Prevention

Admit Orders: 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 ½ 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

-Levofloxacin (Levaquin) 500 mg PO qdOR

  -Trimethoprim/SMX (Bactrim DS) (160/800 mg) one DS tab PO bid.

10
Symptomatic Medications: - Morphine sulfate 5-10 mg IV push prn pain.
 - Zolpidem (Ambien) 5-10 mg qhs PO prn insomnia.
 - Zofran 4mg IV q4-6h prn
 -Acetaminophen (Tylenol) 650 mg 2 tab PO/PR q4-6h prn temp >38°C or pain.
 -Docusate sodium (Colace) 100 mg PO qhs.
 -Famotidine (Pepcid) 20 mg IV/PO q12h.
 -Heparin 5000 U SQ q12h or pneumatic compression stockings
 

11. Extras: Upright abdomen. GI consult.

12. Labs: CMP CBC with differential, UA, blood culture x 2.
1
3.Stool studies: Wright's stain for fecal leukocytes, culture for enteric pathogens, ova and parasites x 3, clostridium difficile toxin.