Hemolytic uremic syndrome

What is hemolytic uremic syndrome?

Hemolytic uremic syndrome (HUS) is a disease that causes the destruction of red blood cells and platelets in the blood. It can sometimes cause kidney damage, or rarely, death. It is caused by a particular strain of the bacteria (germ) Escherichia coli, known as E. coli O157:H7. HUS occurs in about 5% of the children who are infected with this germ. Most children who develop HUS are younger than 5 years old.

How did my child get HUS?

The germs that can cause HUS are found in the feces or stool (bowel movements) of infected people or animals. The germs are spread by "fecal-oral transmission" germs swallowed from foods or objects that were in contact with feces, or hands that were not washed carefully enough). Possible sources include:

• direct contact with infected animal or human feces
• undercooked meat (usually hamburger)
• unpasteurized milk, juice, or cider
• contaminated objects (such as toys)

What are the signs of HUS?

• watery or bloody diarrhea about 1 week before other signs occur
• abdominal (belly) pain or cramps
• bruising or bleeding easily
• decreased urine or blood in urine
• weakness, feeling tired
• pale color
• fever

What is the treatment?

Your child will have an intravenous line (IV) to give fluids, medicines, and calories. A catheter (small tube) may be put into the bladder to measure the amount of urine.

Blood tests will be done to check the hemoglobin (red blood cells), platelet count, and factors that show how well the kidneys are working.
Your child may receive blood transfusions to provide the red blood cells and platelets needed to get well.

If the laboratory tests show that the kidneys need help getting rid of waste products, peritoneal dialysis (PD) will be needed. For this treatment, a catheter will be put into the abdomen (belly) by a surgeon. If PD is needed, your child will be transferred to the Pediatric Intensive Care Unit (PICU). A special fluid is put into the abdomen, where it stays for a period of time and is then drained out. (See the education sheet "Dialysis")

As the blood tests return to normal, your child will feel better and the kidneys will start to make urine again. The PD will be gradually stopped as the kidneys produce more urine. The IV and PD catheter will be removed when your child is eating, drinking, and urinating well. This may take several days or weeks.

To prevent the spread of E. coli germs to others, health care workers caring for your child in the hospital will be wearing gowns and gloves.
You and anyone caring for your child must wash hands well with soap and water or use alcohol hand sanitizer:

• after changing diapers.
• after helping your child use the toilet.
• before handling food or beverages.
• Also, young children should have their hands washed well and often.

What else do I need to know?

When your child goes home from the hospital, you will need to schedule follow- up visits with the doctor. It is very important to keep these appointments. Information on eating, drinking, and urine patterns will be watched closely during these visits. If your child had dialysis, you will be given instructions about changing the bandage and care of the site.

Our infection control department is required to report this disease to the state Department of Health. This is done to determine if there is a common source, which may infect others.

When can my child return to day care?

Your child may return to day care after being off antibiotics for two days and 2 stools at least 1 day apart have tested negative for the E. coli germ. In most cases, the germs will be in the stools for 2 or 3 weeks after the first sign of illness, but in a small number of children it may take several months for all the germs to be gone.

When should I call the doctor?

After your child is discharged from the hospital, call right away if:

• signs of HUS return.
• poor appetite for more than a few days.
• vomiting.
• fever: temperature higher than 101° F (38.4° C).
• redness or drainage at the PD site (if child had PD).

Questions?

This sheet is not specific to your child but provides general information. If you have any questions, please call the doctor.

Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404

Last Reviewed 7/2015 © Copyright

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