Pediatric emergency medicine trisk 2891 2891
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injury may require close monitoring and medical support of end organ
function. Neurologic complications may be severe and require close
monitoring to detect their presence.
CLINICAL PEARLS AND PITFALLS
Hemolytic uremic syndrome (HUS) is characterized by Coombsnegative hemolytic anemia, thrombocytopenia, and AKI but with
normal coagulation studies, helping to differentiate it from
disseminated intravascular coagulation.
It is usually preceded by diarrhea that often becomes bloody as
well as abdominal pain and emesis.
Care is primarily supportive and may include fluid resuscitation,
blood transfusions, and RRT.
Early hydration in the setting of Shiga toxin-producing Escherichia
coli (STEC) enterocolitis may decrease risk of requiring RRT as
well as development of long-term sequelae.
Antibiotics are not indicated in STEC infections as they lead to an
increasedrisk of developing HUS.
Clinical Considerations
Clinical recognition. HUS is characterized by the clinical triad of
microangiopathic hemolytic anemia, thrombocytopenia, and AKI. Its
consequences are the result of microvascular endothelial cell injury. HUS
can be divided into atypical cases and typical forms stemming from Shiga
toxin–producing infections. Atypical HUS is a heterogenous disorder and
may be associated with thrombotic thrombocytomenic purpura or be
precipitated by numerous triggers including inborn errors of metabolism,
drugs, bone marrow transplantation, and nonenteric infections. Typical
HUS accounts for approximately 90% of pediatric cases and is frequently
due to STEC infections, although other organisms such as Shigella
dysenteriae type 1, Salmonella, and Yersinia have been implicated, as well.
Greater than 70% of the cases in the United States are from Escherichia coli
serotype O157:H7. Most cases are sporadic, but outbreaks may occur and
