Here’s a Morning Report from Dr. Julie on Hemolytic Uremic Syndrome:
HUS
- Cause
- EHEC (Shiga toxin-producing enterohemorrhagic E. coli)
- 70% of US HUS cases
- 0157:H7 (Most US cases)
- O104:H4 (Germany last yr)
- 0111 (Australia and US)
- Shigella (Shigella dysenteriae type 1)
- India, Bangladesh, and southern Africa
- Epidemiology
- Illness 90% in kids, mostly <5 yrs
- June to September > 50% of cases
- From cattle intestine and feces
- undercooked meat, unpasteurized milk or milk products, water, fruits or vegetables
- can go horizontally
- Mainly rural
- Pathology/Dx
- abdominal pain, vomiting, and diarrhea
- bloody diarrhea in 57 percent
- no fever
- abd pain, mild leukocytosis
- HUS develops in 5 to 10 days
- HUS
- Hemolytic anemia with fragmented erythrocytes (Hgb 8 or less)
- Thrombocytopenia (<40-140)
- Acute renal injury (50 percent needed dialysis – most recover)
- Seizures and somnolence, were observed in 25 percent
- Low mortality (<5%)
- CLINICAL Dx
- Red flags
- decreasing urine volume
- HTN (in kids)
- Purpura (less common than in HSP)
- Treatment
- Supportive
- Hgb if <6
- Platelets if < 30
- Careful fluid and electrolyte management
- HTN: Tx with dialysis, CCBs
- Plasma exchange for neuro sx
- NO abx
- No anti-motility agents
Thanks Dr. Julie! Leave any comments below.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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