Treatment of HUS in Shiga Toxin-Associated Hemolytic-Uremic Syndrome with Bloody Diarrhea
This protocol addresses the management of hemolytic-uremic syndrome arising in the context of a Shiga toxin-associated gut infection, specifically in patients presenting with bloody diarrhea (dysentery).
Clinical Scenario
The patient presents with Shiga toxin-associated hemolytic-uremic syndrome and active bloody diarrhea (dysentery). Shiga toxin-associated gut infection is one of the chief causes of HUS and is confirmed by stool examination.
Treatment Approach (Partial Overview)
Management in this setting includes early fluid resuscitation to maintain adequate hydration, alongside antibiotic therapy targeting the underlying dysentery. The specific agents, sequencing, monitoring parameters, and full clinical algorithm are detailed in the structured protocol.
Full regimen, dosing, and clinical decision points available via the protocol link below.References
DOI: 10.1007/s00467-019-04233-7
Shiga toxin-associated gut infection is one of the chief causes of HUS and confirmed by stool examination.
We recommend maintaining hydration by early use of isotonic fluids in patients with dysentery, starting from onset of bloody diarrhea to the day of onset of HUS, and monitoring for fluid overload in patients with renal failure.
We recommend therapy with appropriate antibiotics for bloody diarrhea.
Ringer lactate or dextrose saline should be infused during bloody diarrhea and including the day of diagnosis of HUS to prevent dehydration.
Since administration of intravenous fluids is not always feasible, the use of oral rehydration solution to maintain euvolemia is an alternative, but which has not been examined.
Since clinical distinction between shigellosis and STEC infection may be difficult, we recommend that patients with bloody diarrhea receive treatment with oral ciprofloxacin, azithromycin or cefixime for 5 days.
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