HUS

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HUS

Hemolytic uremic syndrome, see there.

hemolytic uremic syndrome

,

HUS

An acute condition consisting of microangiopathic hemolytic anemia, thrombocytopenia, and acute nephropathy. Escherichia coli 0157:H7 (and E. Coli 0111) are causative agents that may be acquired from eating contaminated raw or rare hamburger or other meats. Children are most often affected. Onset may initially involve gastroenteritis and diarrhea or an upper respiratory tract infection. Hallmarks of the acute phase are a purpuric rash, irritability, and lethargy. Findings include oliguria, splenomegaly, mild jaundice, seizures (in some patients), hepatomegaly, pulmonary edema, and renal failure. The acute phase may last from 1 to 2 weeks in mild cases and much longer in severe cases.

Treatment

The treatment of this syndrome is management of the renal failure and anemia. Antibiotics are ineffective.

Prognosis

The usual outcome is complete recovery, but about 5% of affected persons die, and 10% develop end-stage renal disease and require lifelong hemodialysis.

Patient care

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.

Hemolytic-uremic syndrome (HUS)

A potentially fatal complication of E. coli infections characterized by kidney failure and destruction of red blood cells.

HUS

hemolytic uremic syndrome. See also hemoglobinuric nephrosis.
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