CBC: complete blood count; HUS: hemolytic uremic syndrome; IVF: intravenous fluids; STEC: Shiga toxin-producing Escherichia coli; NSAID: nonsteroidal anti-inflammatory drug.
* Features that lower suspicion for STEC include fever at the time of presentation, absence of abdominal pain, diarrhea duration greater than a week at presentation, diarrhea that abates within hours of presentation, evidence of disease chronicity, and known contact with a patient with a microbiologically proven non-STEC bacterial diarrheal infection.
¶ We favor rectal swabs for expediency in obtaining a specimen. In children, rectal swabs have comparably sensitivity to stool specimens.
Δ In children, we usually use 0.9% saline, administered as a bolus of at least 20 mL/kg followed by maintenance infusion of isotonic crystalloid at 1.5 to 2 times maintenance fluid volume, clinical condition permitting.
◊ For the first 24 hours, we check CBC every 8 to 12 hours to monitor the effectiveness of IVF volume expansion, targeting a reduction in the hemoglobin concentration.
§ Other UpToDate authors use more general diagnostic criteria for HUS: the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (defined as a reduction in glomerular filtration rate typically presenting as an abnormally elevated serum creatinine).
¥ The first day of diarrhea is considered the first day of illness.
‡ In the rare event that there is a post-discharge decrease in the platelet count, we typically readmit the patient for an additional day or two of IVF.
† A decrease in platelets is often the first laboratory manifestation of HUS. Based on our clinical experience, a 5% increase in platelet counts between days 5 and 9 of illness (or stabilization of platelet counts later in illness) suggests that the risk for HUS has passed. We have used the 5% threshold to manage many patients without adverse event, but it has not been systematically evaluated.
** A negative stool culture is often requested prior to return to daycare, school, or other sensitive settings (eg, occupation with food preparation). We typically obtain a stool culture prior to discharge from the hospital, as this is more convenient than submitting an outpatient specimen.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟