Hemolytic Uremic Syndrome in Emergency Medicine Clinical Presentation

  • Author: Audrey J Tan, DO; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Sep 26, 2011
 

History

  • Risk factors for hemolytic uremic syndrome in children include eating rare hamburger, a recent trip to a petting zoo, and visiting a nursing home relative with diarrhea.
  • Children usually present following an acute diarrheal illness. The GI prodrome typically occurs 4-6 days following onset of diarrhea and may mimic ulcerative colitis, various enteric infections, or appendicitis.
  • Diarrhea becomes hemorrhagic in 70% of cases, usually within 1-2 days of onset of diarrhea.
  • Vomiting occurs in 30-60% of cases.
  • Urine output may be reduced or absent.
  • Neurologic symptoms are observed in 33% of patients and may include irritability, seizures, or altered mental status.
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Physical

  • Findings of hemolytic uremic syndrome reflect those of the inciting prodromal illness and the end organ in which thrombogenesis is occurring.
  • Fever occurs in 30% of cases.
  • GI bleeding is often noted.
  • GI involvement may lead to symptoms of an acute abdomen, with occasional peritonitis.
  • Cardiac involvement may lead to congestive heart failure (CHF) and arrhythmias.
  • Microinfarcts in the pancreas may cause pancreatitis or rarely, insulin-dependent diabetes mellitus.
  • Ocular involvement may lead to retinal or vitreous hemorrhages.
  • Hypertension and oliguria are typical findings consistent with renal compromise.
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Causes

See Pathophysiology.

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Contributor Information and Disclosures
Author

Audrey J Tan, DO  Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Audrey J Tan, DO is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William G Gossman, MD  Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center

William G Gossman, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, William Shapiro, MD, to the development and writing of this article.

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Peripheral smear in hemolytic uremic syndrome (HUS), with findings of microangiopathic hemolytic anemia. Note schistocytes/helmet cells as well as decrease in platelets. Image courtesy of Emma Z. Du, MD.
 
 
 
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