Q: Which of the following is the greater risk of clinical deterioration at the time of presentation in Shiga toxin-producing Escherichia coli (STEC) infections?A) hyponatremia
Hyponatremia at the time of hemolytic uremic syndrome (HUS) is found to be associated with bad outcomes. Aggressive intravenous fluid resuscitation is the mainstay of treatment with an isotonic solution. Oral resuscitation does not work in HUS due to two reasons. First, enteral electrolyte-containing solutions do not have enough sodium chloride to offer nephroprotection. Second, the severity of vomiting and abdominal pain hinders oral fluid resuscitation. Special attention should be paid as hyperkalemia can quickly develop in these patients due to brisk hemolysis and developing renal failure.
Interestingly and less known fact about IV fluid resuscitation in STEC: HUS is that the adequacy is measured by hemodilution in the early phase which may require Hb level monitoring every 8 hours!
1. Alconcher LF, Coccia PA, Suarez ADC, et al. Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome. Pediatr Nephrol 2018; 33:1791.
2. Ake JA, Jelacic S, Ciol MA, et al. Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 2005; 115:e673.
3. Grisaru S, Xie J, Samuel S, et al. Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin-Producing Escherichia coli: A Systematic Review and Meta-analysis. JAMA Pediatr 2017; 171:68.