Fluid restriction versus volume expansion in children with diarrhea-associated HUS: a retrospective observational study

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

“…Timely fluid administration has been associated with a lower risk of developing HUS in children with EHEC infection [ 208 , 209 , 210 , 211 ]. This action is currently evaluated in a prospective trial (NCT03275792).…”

Hydration in hemolytic uremic syndrome

“…In addition, VE corrected initial hyponatremia, and serum sodium was maintained within normal ranges Regarding neurological complications and mortality, fewer or no events were observed in the VE group, although they did not show statistical differences, which is probably related to the small size of the sample. 19 For this reason, when nephrological monitoring is available and/ or short-term access to a tertiary care hospital is guaranteed, it is suggested to initially hydrate D+HUS patients with no signs of fluid overload, regardless of the status of their renal function, by infusing a 0.9 % saline solution at 10 mL/kg/h over a 3-hour period. Afterwards, if urine output is higher than 0.5 mL/kg/h, the patient should not be dialyzed (except if they have a medically intractable metabolic or electrolyte disorder) and hydration should be continued, according to their needs, with an isotonic saline solution containing 5 % dextrose for 48 hours, in order to maintain an adequate hydration and urine output (Table 1).…”

“…After 48 hours, the number of patients with hyponatremia was statistically and significantly higher in the FR group (p = 0.014). 19…”

Hidratación en el síndrome urémico hemolítico

“…Con respecto a las complicaciones neurológicas y la mortalidad, se encontró menos o ningún evento en el grupo de EV, aunque no mostraron diferencias estadísticas, probablemente, relacionado con el tamaño pequeño de la muestra. 19 Por ello, se propone, inicialmente, bajo control nefrológico y/o, garantizándose el acceso a un centro de alta complejidad a corto plazo, hidratar a todo paciente con SUHD+ sin signos de sobrecarga de líquidos, independientemente del estado de la función renal, infundiendo solución salina al 0,9 % a razón de 10 ml/kg/hora durante tres horas. Luego, si se logra una diuresis superior a 0,5 ml/kg/hora, no dializarlo (excepto que presente un trastorno metabólico o electrolítico intratable médicamente) y continuar la hidratación dependiendo de las necesidades del paciente, con una solución salina isotónica de dextrosa al 5 % durante 48 horas, con el objetivo de mantener una adecuada hidratación y diuresis (Tabla 1).…”

“…Después de 48 horas, el número de pacientes con hiponatremia fue estadística y significativamente mayor en el grupo de RF (p = 0,014). 19…”