Severe Ulcerative Colitis

• IV fluid and electrolyte replacement to correct and prevent dehydration or electrolyte imbalance, with blood transfusion to maintain a hemoglobin of >10 g/dL
• Withdrawal of anticholinergics, antidiarrheal agents, NSAIDs and opioid drugs which can precipitate colonic dilatation
• Controlled trials failed to demonstrate therapeutic benefit of administering antibiotics especially in the absence of infections; however, there are protocols that recommend administration of broad-spectrum antibiotics in patients with severe UC who have signs of toxicity or with worsening condition despite maximal medical therapy
• SC Heparin may be given to reduce the risk of thromboembolism
• Total parenteral nutrition is needed if patient is significantly malnourished

Severe to Fulminant Crohn's Disease 

• If patient is unable to maintain nutritional requirements for 5-7 days, nutritional support via elemental feeding or parenteral hyperalimentation is indicated
• Dehydrated patients should receive fluid and electrolytes as necessary
• Transfusions may be necessary for anemia and active hemorrhage
• Use of opiates and anticholinergics should be limited and antidiarrheal agents avoided 
• Prophylaxis for venous thromboembolism is recommended 
• Oral feeding should continue as tolerated in patients without evidence of intestinal obstruction
• Severely ill patients or those with obstruction should have bowel rest and parenteral support