A 19-year-old man presents to the emergency department with a 3-day history of bloody diarrhea (12-15 stools/day), severe left lower abdominal cramping, and fever. He has no recent travel or antibiotic use. Vital signs: temperature 39.1°C, heart rate 118/min, blood pressure 92/58 mmHg, respiratory rate 20/min. Laboratory findings show hemoglobin 8.8 g/dL, albumin 2.9 g/dL, C-reactive protein 9.2 mg/dL, and negative stool cultures including C. difficile PCR. Colonoscopy reveals continuous friable mucosa with shallow ulcerations extending from the rectum to the mid-colon, with normal mucosa proximally. Which of the following is contraindicated in the management of his acute presentation?
- A)LoperamideGABARITO
- B)Intravenous hydrocortisone
- C)Mesalamine suppositories
- D)Broad-spectrum antibiotics
- E)Fluid and electrolyte replacement
Explicação
Antiperistaltic agents (including loperamide and diphenoxylate) are contraindicated in acute inflammatory bowel disease, particularly ulcerative colitis with severe inflammation. These agents increase the risk of toxic megacolon by reducing colonic motility an... Ver explicação completa e trilha adaptativa →