From the Guidelines
This patient with an acute flare of ulcerative colitis is at greatest risk for venous thromboembolism (VTE). Patients with inflammatory bowel disease, particularly during active flares, have a significantly increased risk of developing VTE due to the hypercoagulable state associated with systemic inflammation 1. The patient's prolonged hospitalization, relative immobility, and active inflammation all contribute to this risk.
Key Factors Contributing to VTE Risk
- Prolonged hospitalization
- Relative immobility
- Active inflammation While bowel perforation and toxic megacolon are potential complications of severe ulcerative colitis, the absence of fever, normal vital signs, and lack of severe abdominal findings (no rebound or rigidity) make these less likely than VTE in this scenario. Pericarditis can occur as an extraintestinal manifestation of inflammatory bowel disease but is much less common than VTE during acute flares.
Comparison of Risks
- Bowel perforation: less likely due to absence of severe abdominal findings
- Toxic megacolon: less likely due to absence of severe abdominal findings
- Pericarditis: much less common than VTE during acute flares Prophylactic anticoagulation should be considered for this hospitalized patient with active ulcerative colitis to reduce the risk of VTE, which represents a significant cause of morbidity and mortality in this population, as supported by the American Gastroenterological Association guidelines 1 and the British Society of Gastroenterology consensus guidelines 1.
From the FDA Drug Label
Use only Bacteriostatic Water For Injection with Benzyl Alcohol when reconstituting methylprednisolone sodium succinate for injection There are reports of cardiac arrhythmias and/or cardiac arrest following the rapid administration of large intravenous doses of methylprednisolone sodium succinate for injection Bradycardia has been reported during or after the administration of large doses of methylprednisolone sodium succinate, and may be unrelated to the speed or duration of infusion
The patient is at greatest risk for Venous thromboembolism due to the following factors:
- Immobility is not explicitly mentioned but can be inferred due to hospitalization
- Inflammation from ulcerative colitis
- Corticosteroid use (methylprednisolone) which can increase the risk of venous thromboembolism 2 However, the provided drug label does not directly answer the question about the patient's risk. The FDA drug label does not answer the question.
From the Research
Risk Assessment for the Patient
The patient is at risk for several complications due to his acute flare of ulcerative colitis. Considering his symptoms and laboratory results, the following risks are identified:
- Toxic Megacolon: The patient is at greatest risk for toxic megacolon, a life-threatening complication of ulcerative colitis characterized by extreme dilation of the colon 3, 4, 5, 6, 7. The patient's symptoms, such as generalized abdominal pain and cramping, diarrhea with bright red blood, and generalized tenderness without rebound or rigidity, are consistent with toxic megacolon.
- Bowel Perforation: The patient is also at risk for bowel perforation, which is a complication of toxic megacolon 7. However, the abdominal radiograph shows no bowel obstruction, which reduces the risk of perforation.
- Venous Thromboembolism: The patient's laboratory results, such as a leukocyte count of 13000, indicate an increased risk of venous thromboembolism 4. However, this risk is not as directly related to his current symptoms as toxic megacolon.
- Pericarditis: The patient's laboratory results do not indicate an increased risk of pericarditis.
Key Factors Contributing to the Risk
The following factors contribute to the patient's risk of toxic megacolon:
- History of ulcerative colitis: The patient has had ulcerative colitis for the past ten years, which increases his risk of toxic megacolon 3, 4, 5, 6, 7.
- Unsuccessful outpatient management: The patient's outpatient management has been unsuccessful, which increases his risk of toxic megacolon 5.
- Electrolyte imbalances: The patient's serum potassium level is 3.3, which indicates an electrolyte imbalance and increases his risk of toxic megacolon 5.