Hemolytic Uremic Syndrome in Emergency Medicine Clinical Presentation

Updated: Jan 21, 2015
  • Author: Audrey J Tan, DO; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Presentation

History

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  • 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

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  • 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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