Abstract
A retrospective analysis of data from a series of 22 patients with toxic megacolon complicating ulcerative colitis was performed in an attempt to detect factors associated with the fatal outcome of the attack. Of the 25 clinical findings studied, significant differences between survivors (17) and nonsurvivors (5) were observed in only seven. In nonsurvivors, duration of the disease was longer and blood pH and standard bicarbonate levels higher, whereas serum potassium, calcium, phosphorus, and β-globulins were lower. Discriminant analysis showed that three pairs of features, namely potassium-β-globulins, potassium-bicarbonate, and potassium-blood pH provided a good discrimination between survivors and nonsurvivors. Results of this study indicate that the severity of the electrolyte and metabolic disorder appears to be an important risk factor in toxic megacolon. Intensive fluid and electrolyte replacement should therefore be considered a crucial point for successful management of toxic megacolon.
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Binder SC, Patterson JF, Glotzer DJ: Toxic megacolon in ulcerative colitis. Gastroenterology 66:909–915, 1974
Collier RL, Wylie JH, Gomez J: Toxic megacolon: A surgical disease. Am J Surg 121:283–288, 1971
Jalan RM, Sircus W, Card W, Falconer CWA, Bruce J, Crean GP, McManus JPA, Small WP, Smith AN: An experience of ulcerative colitis. I. Toxic dilatation in 55 cases. Gastroenterology 57:68–82, 1969
Neschis M, Siegelman SS, Parker JC: Diagnosis and management of the megacolon of ulcerative colitis. Gastroenterology 55:251–259, 1968
Baràny F, Lindholmer B: Improtance of early intensive treatment in severe attacks of ulcerative colitis. Rendic Gastroenterol 6:1–5, 1974
Goligher JC, De Dombal FT, Watts JMK, Watkinson G: Ulcerative Colitis. London, Bailliére, Tindall and Cassel, 1968
Strauss RJ, Flint GW, Platt N, Levin L, Wise L: The surgical management of toxic dilatation of the colon. Ann Surg 184:682–688, 1976
Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC: Assessment of severity in colitis: A preliminary study. Gut 16:579–584, 1975
Caprilli R, Vernia P, Colaneri O, Torsoli A: Blood pH: A test for assessment of severity in proctocolitis. Gut 17:763–769, 1976
Nordin BEC: Calcium, phosphate and magnesium metabolism. Clinical Physiology and Diagnostic Procedures. Edinburgh, Churchill and Livingstone, 1976
Caprilli R, Sopranzi, N, Colaneri O, Levi Della Vida M, De Magistris L: Salt-losing diarrhoea in idiopathic proctocolitis. Scand J Gastroenterol 13:331–335, 1978
Caprilli R, Frieri G, Simonetti BM, Pierucci A, Cinotti GA: Renal response to diarrhoea.In Gastrointestinal Emergencies II, F Baràny, R Caprilli, R Shields (eds). Oxford, Pergamon Press, 1980
Valentin N, Nielsen OV, Olesen KH: Muscle cell electrolytes in ulcerative colitis and Crohn's disease. Digestion 13:284–290, 1975
Lockwood CM, Harris J, Clark CG: Intracellular potassium in diffuse proctocolitis. Lancet 1:889–891, 1971
Binder HJ, Ptak T: Jejunal absorption of water and electrolytes in inflammatory bowel disease. J Lab Clin Med 76:915–924, 1970
Wacker WEC, Parisi AF: Magnesium metabolism. N Engl J Med 278:712–717, 1963
Matko M: Magnesium deficiency in ulcerative colitis. J Fla Med Assoc 53:1063–1067, 1966
Raisz LG: Calcium, phosphate, magnesium and trace elements.In Clinical Disorders of Fluid and Electrolyte Metabolism. MM Maxwell, CR Kleeman (eds). New York, McGraw-Hill, 1972, pp 347–399
Knochel JP, Barcenas C, Cotton JR, Fuller TJ, Haller R, Carter NW: Hypophosphatemia and rhabdomyolisis. J Clin Invest 62:1240–1246, 1978
Fuller TJ, Wilmer WW, Brenner BJ, Peterson JC: Reversible depression in myocardial performance in dogs with experimental phosphorus deficiency. J Clin Invest 62:1194–1200, 1978
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Caprilli, R., Vernia, P., Colaneri, O. et al. Risk factors in toxic megacolon. Digest Dis Sci 25, 817–822 (1980). https://doi.org/10.1007/BF01338522
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DOI: https://doi.org/10.1007/BF01338522