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 2024/10/08 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.