Pediatric emergency medicine trisk 2893 2893

generally normal, distinguishing HUS from sepsis and disseminated
intravascular coagulation. A Coombs test will be negative. A stool culture
may help identify the causative organism but will not alter medical
management of AKI.
The severity of the renal involvement in typical HUS varies widely and is
not related to the degree of anemia present. AKI may be mild and selflimited, associated with microscopic hematuria, mild proteinuria, and
preserved renal function. When renal microangiopathy is severe, fulminant
oligoanuric renal failure may ensue and necessitate RRT.
Management. Early IV hydration in the setting of known STEC
enterocolitis is important. Fluid administration, especially early in the
course of illness when diarrhea may be present without signs of HUS, is
associated with a decreased risk of requiring RRT, shorter hospital stays,
and decreased risk of long-term sequelae. Supportive care is the mainstay of
therapy for typical HUS, once developed. If intravascular volume depletion
is present due to gastrointestinal losses and poor intake, fluid resuscitation
with isotonic saline should be provided with repeated assessment of volume
status in an effort to decrease the compounding effects of prerenal AKI.
Once the intravascular volume status has been restored, further fluid
management should be guided by renal function and urine flow. If oliguria
is present, a trial of furosemide (0.5 to 1 mg/kg/dose) may be provided to
establish urine flow, although patients may require doses much larger than
typical (up to 5 mg/kg/dose). If oliguria persists, fluids should be provided
at a rate to ensure adequate intravascular volume but avoid volume excess.
Both IV and oral intake should match the total of measurable output (urine
and gastrointestinal losses) and insensible water losses, estimated at 300 to
400 mL/m2/day. Frequent monitoring of fluid balance, weight, and vital
signs is essential. Hypertension may be managed with calcium channel
blockers.
Anemia associated with typical HUS may be severe. Packed red blood
cell transfusions should be provided for symptomatic anemia or robust
hemolysis with a hemoglobin <6 to 7 mg/dL. Transfusions should occur

slowly given the concern for fluid balance issues. If the patient is oliguric, it
may need to be performed while on dialysis to avoid volume excess and
hyperkalemia. Due to microangiopathy, transfused platelets will be quickly
consumed and not lead to a sustained increase in the platelet count. Platelet