MDCalc » Gastroenterology

King’s College Criteria

admin — Thu, 18 Mar 2010 11:53:44 +0000

Grade 1 - Inverted sleep pattern; forgetfulness, mild confusion, agitation, irritability, tremor, apraxia
Grade 2 - Lethargy, slow responses; Disorientation for time or place, Subtle personality change; Asterixis, dysarthria, ataxia
Grade 3 - Somnolence but rousability, Disorientation as regards place; Asterixis, hyperactive reflexes, Babinski signs, muscle rigidity
Grade 4 - Coma (unresponsive to verbal or noxious stimuli)

admin — Thu, 08 Oct 2009 03:34:18 +0000

Glasgow-Blatchford Score

Blood Urea
≥6·5 <8·0	2
≥8·0 <10·0	3
≥10·0 <25·0	4
≥25	6
Hemoglobin (g/L) for men
≥12.0 <13.0	1
≥10.0 <12.0	3
<10.0	6
Hemoglobin (g/L) for women
≥10.0 <12.0	1
<10.0	6
Systolic blood pressure (mm Hg)
100–109	1
90–99	2
<90	3
Pulse ≥100 (per min)	1
Presentation with melaena	1
Presentation with syncope	2
Hepatic disease	2
Cardiac failure	2

Low risk = Score of 0. Any score higher than 0 is "high risk" for needing a medical intervention of transfusion, endoscopy, or surgery.

admin — Wed, 11 Feb 2009 14:15:18 +0000

admin — Fri, 02 Jan 2009 04:30:45 +0000

Stool Osmolal Gap = Stool Osm - (2 * (Na + K) )

Causes of osmotic diarrhea include:

Causes of secretory diarrhea include:

Lactate > 3.5 mg/dL (0.39 mmol/L) 4 hrs after early fluid resuscitation?	Yes
pH < 7.30 or lactate > 3 mg/dL (0.33 mmol/L) after full fluid resuscitation at 12 hours	Yes
INR > 6.5 (PTT > 100s)	Yes
Creatinine > 3.4 mg/dL (300 µmol/L)	Yes
Grade 3 or 4 Hepatic Encephalopathy?	Yes
Phosphorus > 3.75 mg/dL (1.2 mmol/L) at 48 hours	Yes

Is patient female?	Yes
Hemoglobin	g/dL
BUN	mg/dL
Initial Systolic Blood Pressure	mm Hg
Heart Rate ≥ 100	Yes
Does the patient have melena?	Yes
Did the patient have syncope?	Yes
Does the patient have hepatic disease?	Yes
Does the patient have heart failure?	Yes
Score	points

Total Bilirubin	<2 mg/dL (<34 µmol/L) +1 2-3 mg/dL (34-50 µmol/L) +2 >3 mg/dL (>50 µmol/L) +3
Albumin	>3.5 g/dL (>35 g/L) +1 2.8-3.5 g/dL (28-35 g/L) +2 <2.8 g/dL (<28 g/L) +3
INR	<1.7 +1 1.7-2.2 +2 >2.2 +3
Ascites	No Ascites +1 Ascites, Medically Controlled +2 Ascites, Poorly Controlled +3
Encephalopathy	No Encephalopathy +1 Encephalopathy, Medically Controlled +2 Encephalopathy, Poorly Controlled +3
Score	points

Stool Na	mEq/L
Stool K	mEq/L
Stool Osm	mOsm/kg
Stool Osmotic Gap	mOsm/kg
>100 suggests osmotic diarrhea, < 100 suggests secretory diarrhea