HEMOLYTIC-UREMIC SYNDROME

Question 1

Definition

Answer 1

Recent exposure to Shiga-producing E. Coli 0157:H7

Acute Renal Failure
Thrombocytopenia
Microangiopathic Hemolytic Anemia

Question 2

History & Physical

Answer 2

Nausea
Vomiting
Blood Diarrhea

Ask about:
Recent exposure to unpasturized milk, undercooked meat, contaminated produce

Ask about:
seizures
oliguria
Fatigue / pallor
confusion (encephalopathy)

Question 3

Complications

Answer 3

Seizures
Renal Failure
Anemia
Encephalopathy

Question 4

Investigations / Diagnosis

Answer 4

CBC: anemia (5-9), thrombocytopenia (<150,000)

PBC: schistocytes, helmet cells, burr cells

Stool Gram Stain, C & S, O&P for Shiga toxin and E.Coli 0157:H7

Question 5

Management

Answer 5

Primarily Supportive

CIRCULATION:

Mild to Moderate Hypovolemia:
Oral Rehydration Solution

Goal: replace deficits over 4-6 hrs and replace ongoing losses

Mild - 1 ml / kg / 5 min
Moderate - 2 ml / kg / 5 min

Pedialyte:

45 mEq/L Sodium
140 mEq/L Glucose

Severe Hypovolemia:
IF dehydrated
20 ml / kg IV bolus NS over 15-20 min
Repeat until perfusion improves and urine output is adequate

THEN
Maintenance 4 cc / hr for 1st 10 kg, 2 cc / hr for 10-20 kg, 1 cc / hr per kg for every kg > 20 kg

D5 NS + 20 mEq/L KCL if isotonic dehydration

D5 1/2 NS + 20 mEq KCL if hypernatremic dehydration

MONITOR FOR FLUID OVERLOAD

No platelet transfusion

Antibiotics and Antiperistaltics are CONTRAINDICATED