Tarr et al outlined how to manage a patient with the hemolytic-uremic syndrome (HUS) associated with exposure to a Shiga toxin-producing strain of Escherichia coli. The authors are from Washington University in St Louis, the University of Vermont, Barbara Bush Children's Hospital in Portland, Maine.


Therapy for the affected patient is typically supportive, avoiding certain therapies that have been shown to be ineffective or detrimental.



(1) Maintain intravascular volume while monitoring for fluid overload.

(2) Monitor for hypokalemia and replace potassium if needed.

(3) Monitor blood pressure and urine output.

(4) If the patient develops renal failure:

(4a) monitor for hyperkalemia and hyperphosphatemia.

(4b) institute dialysis if needed

(5) Discontinue nephrotoxic drugs.

(6) Be prepared for neurological complications such as altered mental status, stroke, and seizures.

(7) Transfuse if necessary, using leukoreduced products and infusing slowly.


Therapies to be avoided:

(1) therapy with antibiotics

(2) therapy with antimotility agents

(3) therapy with meperidine or other narcotics that may accumulate during renal failure

(4) therapy with NSAIDs (due to effect on renal perfusion)

(5) therapy with aspirin or antiplatelet drugs

(6) anticoagulation with heparin

(7) administration of urokinase or streptokinase

(8) plasmapheresis or plasma exchange

(9) therapy with corticosteroids

(10) oral therapy against Shiga toxin


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