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HUSHemolytic uremic syndrome, see there.
hemolytic uremic syndrome,
The treatment of this syndrome is management of the renal failure and anemia. Antibiotics are ineffective.
The usual outcome is complete recovery, but about 5% of affected persons die, and 10% develop end-stage renal disease and require lifelong hemodialysis.
If the child has been anuric for 24 hr or demonstrates oliguria with seizures and hypertension, the physician places a peritoneal catheter and the nurse institutes peritoneal dialysis as prescribed, with fluid replacement based on estimated sensible and insensible losses. Fluid and electrolyte balance, complete blood count, body weight, sensorium, and vital signs are carefully monitored, and blood urea nitrogen and azotemia levels are followed to evaluate therapy. Hypertension is reported and controlled with antihypertensive drugs. Severe anemia is treated with fresh, washed packed red blood cells; careful assessment is required throughout the transfusion to prevent circulatory overload, hypertension, and hyperkalemia. Seizures are managed by treating specific causes when known (hypertension, hyponatremia, hypocalcemia), and with anticonvulsant drugs as required. The patient is protected from injury during seizure activity, with the airway guarded. Heart and breath sounds are auscultated periodically, as cardiac failure with pulmonary edema can occur in association with hypervolemia. Prevention and treatment include water and sodium restriction and diuretic therapy, if prescribed. Meeting the child's nutritional needs can be difficult, as concentrated foods must be ingested without fluids and the child may be nauseated. The dietitian should be consulted for nutrition management. The child who is quite ill also may be irritable, restless, anxious, and frightened by frequent painful and stress-producing tests and treatments. Comfort and stability are provided in this threatening environment. Whenever possible, arrangements are made for one or both parents to remain with their child at all times. Support and reassurance are given to the parents and significant others, who are stressed by the severity of the illness and who may experience a degree of guilt if the illness resulted from ingestion of contaminated or raw foods. The family benefits not only from explanations about tests and treatments and information about their child's progress but also from sympathetic listening.