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.
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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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