S tr e s s U lc e r P r o p h y la x is A lg o r ith m

Is s tr e s s u lc e r p r o p h y la x is in d ic a t e d ?

D o e s t h e p a t ie n t h a v e r is k fa c t o r s f o r S t r e s s U lc e r s ?

Yes N o

C a n t h e p a t i e n t a b s o r b o r a l m e d ic i n e s ?
C o n t i n u e p e r io d ic m o n it o r i n g .

Yes N o
Risk Factors for Stress Ulcers:
(One or more risk factors required to initiate
* G i v e r a n i t i d i n e g r a n u l e s 1 5 0 m g P O / N G b id * G i v e f a m o t id i n e 2 0 m g i v q 1 2 h r s prophylaxis)
( A d j u s t f o r r e n a l i n s u f f i c ie n c y ) ( A d ju s t f o r r e n a l in s u f fic ie n c y )
*Mechanical Ventilation > 48hrs
*Coagulopathy
Criteria for assessing use of PO agents for Stress Ulcer Prophylaxis
*History of recent GI bleed
• Patient Inclusion Criteria: *Spinal cord injury
 The patient is receiving an oral medicine (PO,PEG, NG) that relies upon *Glasgow coma score < 11
gastrointestinal absorption for efficacy. *Burns covering >35% of BSA
 The patient is receiving an oral diet. *Organ transplant
 The patient is receiving tube feeds of at least 50% of their goal rate. *Hepatic failure
• Patient Exclusion Criteria: *Multiple trauma (Injury severity score >/= 16)

 Patients who are hemodynamically unstable. *Short bowel syndrome

 Patients designated NPO for any reason. *At least 2 of the following:

 Patients receiving scheduled antiemetics. - Sepsis, ICU stay > 1 week, occult bleeding >/= 6
days, use of high dose steroids (hydrocortisone
 Patients with mucositis and/or receiving chemotherapy that causes >250mg per day or equivalent)
mucositis.
 Patients who are being treated for active GI bleed.

*May also consider carafate 1gm qid

NOTE: For patients already stabilized on proton pump inhibitors, maintain coverage
with either pantoprazole iv or po. Use esomeprazole for NG/GT/PEG administration.
Renal Dosing Recommendations:
• Famotidine IV: CrCl < 10 ml/min = 20mg IV QD
HD = 20mg IV QD / CVVHD = 20mg IV Q12hrs
• Ranitidine granules: CrCl < 50ml/min = 150mg PO/PEG/NG QD
CrCl < 10ml/min = 75mg PO/PEG/NG QD
HD = 150mg PO/PEG/NG QD / CVVHD = 150mg bid