The patient with toxic megacolon has severely decreased or halted colonic peristalsis. Therefore, any medication that further slows intestinal motility is contraindicated in this patient due to the risk for intestinal perforation. The patient requires aggressive fluid replacement to prevent going into hypovolemic shock; an order for 1 L normal saline is appropriate. A nasogastric tube connected to suction is important for bowel rest. Prone positioning facilitates the redistribution of intestinal gas and can be helpful to prevent bowel perforation.