Toxic colitis requires early involvement on the part of the surgeon. At the Cleveland Clinic, toxic colitis is defined by the presence of two or more signs of systemic toxicity: T > 38.0 °C, P > 100 bpm, WBC > 10,000/μl, Albumin <3.5 g/dl. Dilation of the colon > 5 cm is considered abnormal. Patients with toxic colitis require multidisciplinary management, including fluid resuscitation, nutritional support, and intravenous corticosteroids. Medications that can worsen the condition (notably opioids, antidiarrheal agents, anticholinergics, and NSAIDs) are stopped. Surgery is considered in the presence of toxicity, with or without megacolon.