RT Book, Section
A1 Daphtary, Kshama
A2 Usatine, Richard P.
A2 Sabella, Camille
A2 Smith, Mindy Ann
A2 Mayeaux, E.J.
A2 Chumley, Heidi S.
A2 Appachi, Elumalai
SR Print(0)
ID 1114872904
T1 Hemolytic Uremic Syndrome
T2 The Color Atlas of Pediatrics
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-176701-9
LK accesspediatrics.mhmedical.com/content.aspx?aid=1114872904
RD 2024/04/19
AB A  4-year-old  boy  presents  to  his  pediatrician  because  of  swelling  over  the  face,  malaise,  fatigue,  and  decreased  appetite.  On  further  questioning,  his  parents  state  that  he  appears  pale  and  has  reduced  urine  output.  He  recently  finished  a  course  of  antibiotics  for  bloody  diarrhea.  On  exam,  he  is  found  to  be  hypertensive  and  pale  and  has  anasarca.  Initial  laboratory  studies  show  a  hemoglobin  of  7  g/dL,  platelet  count  of  44,000/mm3,  blood  urea  nitrogen  of  39  mg/dL  and  creatinine  of  2.9  mg/dL.  Peripheral  smear  shows  the  presence  of  schistocytes  and  a  paucity  of  platelets  (Figures  69-1  and  69-2).  He  is  admitted  to  the  pediatric  intensive  care  unit  for  hemolytic  uremic  syndrome.  He  is  treated  conservatively  with  close  attention  to  fluid  intake  and  output,  restriction  of  sodium  and  fluid  intake,  and  antihypertensive  medications  as  needed.  A  stool  culture  obtained  at  the  onset  of  his  bloody  diarrhea  grows  Escherichia  coli  and  is  identified  as  serotype  0157:H7.  Hemoglobin  declines  to  5.2  g/dL  for  which  he  is  transfused  packed  red  blood  cells.  Platelet  count  decreases  over  the  next  few  days  and  then  improves.  He  has  no  evidence  of  bleeding.  Azotemia  and  oliguria  improve  over  a  week,  appetite  improves  and  anasarca  resolves.  He  is  discharged  home  with  an  excellent  prognosis  for  full  recovery.