Acute Gastroenteritis: Hemolytic Uremic Syndrome (HUS)

Background/epidemiology 

• HUS is a rare but serious sequela to some gastrointestinal infections, most commonly shiga-toxin producing E. coli (STEC). 
• HUS occurs in 15% of children < 5 years of age (6% of patients of all ages) with lab-confirmed E. coli 0157 infection. 
• HUS should be considered in patients with bloody diarrhea, ill appearance, or close contact to a person with STEC gastroenteritis.  
• Bloody diarrhea may present 2 - 3 days after onset of diarrhea. However, not all patients with HUS experience bloody diarrhea. 
   

Recommendations: 

• Patients should not be treated with antibiotics or anti-motility medication.  
• If presenting after day 5 of illness, obtain CBC. Thrombocytopenia is often the first laboratory evidence of HUS. If presenting on or before day 5, ensure outpatient follow-up for CBC. Anemia alone, without thrombocytopenia, is unlikely to represent HUS.  
• BMP may reveal elevated creatinine and/or BUN. 
• Primary care provider follow-up should occur 5 - 7 days after onset of illness.
• Educate patients and families on return precautions specific to HUS.
   

Reference: 
American Academy of Pediatrics, Committee on Infectious Diseases. (2021) Red Book: 2021–2024, Report of the Committee on Infectious Diseases (No. Ed. 32) . American Academy of Pediatrics. https://doi.org/10.1542/9781610025782