How is pediatric hemolytic uremic syndrome (HUS) prevented?

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

Avoid ingestion of raw or undercooked meat.

Avoid unpasteurized milk and cheese.

Practice good hand-washing technique, especially during outbreaks of diarrhea.

Wash hands well after touching livestock, farm animals, or "petting zoo" animals. Supervise children to ensure good technique.

Avoid taking antidiarrheal or antimotility agents for diarrhea. Avoid taking antibiotics for diarrhea unless under the management of a physician.

Seek medical care immediately for bloody diarrhea.

Preventive measures for medical practitioners

Avoid antibiotic treatment of patients with possible GI E coli 0157:H7 infection, unless other clinical factors require antibiotic therapy. [43]

Use ample parenteral volume expansion with isotonic (normal) saline in patients with suspected E coli 0157:H7 infection (eg, those with bloody diarrhea). Early recognition is important.

A study has shown that early and ample rehydration with isotonic saline is associated with a lower risk of developing oligoanuric renal failure. [8] Many patients who received this therapy still developed hemolytic-uremic syndrome, but they had a less severe course, with shorter lengths of stay and fewer patients requiring dialysis. Ake et al recommend that patients with suspected E coli 0157:H7 infection be admitted for inpatient therapy, using intravenous isotonic saline for both maintenance and replacement fluid requirements, avoiding use of hypotonic fluids. The authors of this article concur with this advice. Trials of oral rehydration, normally an appropriate practice, should be avoided in this situation due to the risk of prolonged renal hypoperfusion.

Monitor fluid status, intake, and output closely because renal function may change rapidly, requiring adjustments to fluid therapy. Use potassium supplementation with great caution.


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