What is the role of fluid therapy in the treatment of pediatric hemolytic uremic syndrome (HUS)?

Updated: Nov 12, 2018
  • Author: Robert S Gillespie, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Answer

Early and ample hydration with intravenous isotonic saline is associated with a lower risk of progression to oligoanuric hemolytic-uremic syndrome in patients with diarrhea (see Deterrence/Prevention). [8] Studies on fluid therapy in patients with established hemolytic-uremic syndrome are lacking; however, based on the data above, the authors recommend that patients with hemolytic-uremic syndrome continue to receive intravenous isotonic saline to maintain a euvolemic state.

Monitor hydration status closely and frequently. This includes serial and frequent measurements of body weight, fluid intake and output, heart rate, and blood pressure. Renal function may rapidly decline, so laboratory test results obtained in the morning may not reflect the patient's renal function or electrolyte status later in the day. Patients may develop fluid overload or hyperkalemia if not carefully managed.

Monitor electrolytes. Testing may need to be performed frequently in the early stages of disease or while children are on dialysis. In children in whom kidney function is stable, testing may be performed daily.

Use potassium-free fluids until renal function has stabilized. Mild hypokalemia is tolerable and much less critical than hyperkalemia. Treat severe or symptomatic hypokalemia with very cautious potassium replacement.

Once fluid deficits have been replaced, restrict fluid replacement to insensible losses plus actual output.

A study by Ardissino et al explored the benefits of volume expansion after hemolytic uremic syndrome (HUS) onset, and compared those results to historical controls. The study found that patients undergoing fluid expansion of at least 10% soon after the diagnosis, showed a mean increase in body weight of 12.5%, had significantly better short-term outcomes with a lower rate of central nervous system involvement, had less need for renal replacement therapy or intensive care unit support, and needed fewer days of hospitalization. The study also added that long-term outcomes were also significantly better in terms of renal and extrarenal sequelae, compared to the historical controls from the same instituion. [9]


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