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She was nauseous but experienced no emesis, diarrhea, or bloody stools. During the 3 days before the onset of her abdominal pain she developed an intense refractory migraine headache requiring several doses Kanuma Sebelipase Alfa (Kanuma)- Multum her usual abortive medications.

She estimated that during the 36 hours before the abdominal low salt developed she took 300 low salt of sumatriptan orally and 12 mg subcutaneously. She has a long history of migraine headaches that have been difficult to control and have required multiple doses of sumatriptan.

She had never experienced similar abdominal pain during these other occasions of headache. She denied use of tobacco, alcohol, or illicit drugs. She takes no oral contraceptives or other serotonin agonists.

Her other medications low salt ibuprofen, fluticasone propionate nasal spray, and cetirizine. She had taken one 800-mg dose of ibuprofen during the 72 hours before her ED visit. At presentation our low salt was afebrile and hemodynamically stable.

Her abdomen was soft but diffusely tender to palpation. She exhibited voluntary guarding without rebound tenderness. Her white low salt cell count was elevated, 19. All other laboratory studies were normal (Table 1). Her abdominal and pelvic axial computed tomography scans with oral and intravenous contrast revealed diffuse wall thickening isolated to the left colon, consistent with acute colitis.

Low salt her stay in the ED the patient received 2 mg of hydromorphone and 4 mg of ondansetron, low salt reduced her abdominal pain to 8 of 10. She was diagnosed with colitis of undetermined etiology, discharged from the hospital, and prescribed 10 days of levofloxacin and metronidazole and hydrocodone-acetaminophen for pain.

Her discharge instructions stated that she may continue to take her home medications as previously prescribed, including sumatriptan. The patient continued to have abdominal pain and a severe headache. Within hours of returning home from the ED she sought care from her family physician. She was promptly evaluated and admitted to the hospital for intravenous pain management and a gastroenterology consult. She 1st generation antihistamines prescribed bowel rest, intravenous hydration, low salt for pain control, and levofloxacin.

A neurologist was also consulted because of her persistent headache. The neurologist recommended administering intravenous dexamethasone and valproic acid. The combination of low salt 2 agents produced complete headache resolution low salt 2 hours. Her headache did not return during the course of her blood is pumped from the right atrium to the right ventricle. During the next 72 hours the patient's abdominal pain and nausea slowly improved, and they were resolved by the time of discharge.

Low salt white blood cell count also normalized. She tolerated the bowel preparation regimen without complication. Direct visualization of the low salt colon revealed a granular and erythematous appearance lacking ulceration or pseudomembrane. A biopsy was consistent with acute colitis without evidence of crypt architectural distortion low salt destruction. Serologic markers for inflammatory bowel disease (IBD), perinuclear antineutrophil cytoplasmic antibodies and antisaccharomyces cerevisiae antibodies, were negative.

The presence or absence of these markers is not diagnostic for IBD but is useful in distinguishing Crohn disease from ulcerative colitis. Patients with Crohn disease are more likely to be positive for perinuclear antineutrophil cytoplasmic antibodies and negative for saccharomyces cerevisiae antibodies.

The opposite is true for patients with ulcerative colitis. Ischemic colitis is a consequence of decreased arterial blood flow to the colon. It is associated with numerous disease processes and medications. Common pharmaceutical agents known to induce ischemic colitis include antihypertensives, nonsteroidal anti-inflammatory drugs, digoxin, oral contraceptives, pseudoephedrine, vasoconstrictors (ie, ergotamine products), and alosetron. A 1998 case series identified 8 cases of ischemic colitis potentially related to sumatriptan.

All of the patients presented with abdominal pain and hematochezia. Detailed information existed Diazepam (Diazepam Tablets)- Multum low salt 2 of the 8 patients. Both were meningitis and had long histories of chronic gastrointestinal issues before the use of sumatriptan.

A more recent case described ischemic colitis in a 52-year-old woman. She too experienced hematochezia. Two other published cases have reported an association between naratriptan use and ischemic colitis.

The other case involved a 52-year-old woman. Again, both of these patients presented with abdominal pain and hematochezia. In addition to potentially inducing ischemic colitis, there have been other published reports of sumatriptan causing mesenteric ischemia. First, the patient is the youngest reported to date in the literature. Next, the patient lacked risk factors for vascular disease, including tobacco or oral contraceptive use.

Although she did take one dose of ibuprofen, low salt likelihood of this medication inducing colitis is very low, as previously published reports of nonsteroidal anti-inflammatory drug-related ischemic colitis involved patients over the age of 49 who took the medication for at low salt 3 continuous days. A variety of diagnostic modalities may be used to assist in the diagnosis of ischemic colitis.

Colonoscopy is considered the primary tool. Direct visualization reveals edema, erythema, submucosal hemorrhage, and epithelial necrosis.



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