Clostridium difficile colitis is being recognized with increasing frequency. Severe, fulminant disease can lead to multi-organ failure, shock and death.
Parameters:
(1) heart rate
(2) percent band forms in blood differential (left shift)
(3) respiratory function
(4) renal function
(5) blood pressure
Parameters
Mild Disease
Moderate Disease
Severe Disease
heart rate
normal
> 90 beats per minute
> 120 beats per minute
percent band forms
normal
11-30%
> 30%
respiratory function
normal
mild tachypnea
respiratory failure, may require mechanical ventilation
renal function
normal
mild oliguria, responds to fluid challenge
severe oliguria to anuria
blood pressure
normal
mild hypotension (systolic pressure > 100 mm Hg)
moderate to severe hypotension, may require vasopressors
where:
• The original table listed "mechanical intubation" for respiratory function in severe disease.
• Severe disease involves multi-organ failure.
• Patients with fuliminant disease may require colectomy.
Limitations:
• It is important to distinguish changes due to the C. difficile colitis from those caused by concurrent disease.
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