This handout is for acute mesenteric ischemia. Your care team identified this based on: severe abdominal pain out of proportion to exam findings (wses 2017 hallmark).
Other reasons your team may use this plan: sudden severe periumbilical pain with vomiting / diarrhea (sma embolism); atrial fibrillation, recent mi, or known atherosclerosis with new abdominal pain (embolic source); unexplained lactic acidosis + abdominal pain (late finding, transmural infarction).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| heparin | 80 U/kg IV bolus then 18 U/kg/h infusion titrated to aPTT 1.5-2.5x control (or anti-Xa 0.3-0.7) | IV | continuous | WSES 2017 — IV UFH first-line for all AMI etiologies; preferred over LMWH due to titrability and potential need for emergent surgery |
| crystalloid_resuscitation | Balanced crystalloid 20-30 mL/kg IV titrated to MAP ≥65 and UOP ≥0.5 mL/kg/h | IV | continuous | WSES 2017 — restore perfusion; avoid excessive saline (worsens acidosis) |
Plan: Acute mesenteric ischemia — etiology-driven anticoagulation + revascularization + sepsis support (WSES 2017)
Call 911 or go to the nearest emergency room right away if you have:
Long-term anticoagulation per etiology (MVT lifelong if unprovoked / thrombophilia; arterial per source); short-bowel syndrome management if extensive resection; nutrition support; secondary prevention (statin, antiplatelet, AF anticoagulation) (WSES 2017)
Guideline: WSES 2017 Acute Mesenteric Ischaemia Guidelines (Bala et al, World J Emerg Surg 2017)