Initial management largely supportive with early fluid resuscitation
Insulin therapy if hyperglycemic and ketones (pancreatic insufficiency complication)
Antihypertensives
NifedipineER (0.25-0.5 mg/kg/day oral)
Labetalol 1-3 mg/kg/day, divided into twice daily dosing (12 mg/kg/day up to 1200 mg/day)
Nitroprusside 0.3-0.5 ug/kg/min IV (max 10 ug/kg/min)
Plasma exchange (plasmapheresis)
Usually performed if anuria or neurologic sequela
Eculizumab
Monoclonal anti-C5 antibody that interrupts complement cascade
Transfusion of RBCs(only severe bleeding)
Generally only indicated if plasma exchange cannot be performed immediately
Platelet transfusion is AVOIDED
Only used for life-threatening bleeding or intracranial hemorrhage under guidance from hematologist
Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death
Hemodialysis/Hemoperfusion
Usually reserved for symptomatic uremia, azotemia (BUN >80 mg/dL), fluid overload or electrolyte abnormalities refractory to medical therapy
AVOID Antibiotics
May lead to worsening lysis of bacteria and further shiga toxin release
AVOID Antimotility agents
Leads to prolonged gut exposure to toxins
Risk of toxic megacolon
NifedipineER (0.25-0.5 mg/kg/day oral)
Labetalol 1-3 mg/kg/day, divided into twice daily dosing (12 mg/kg/day up to 1200 mg/day)
Nitroprusside 0.3-0.5 ug/kg/min IV (max 10 ug/kg/min)
Usually performed if anuria or neurologic sequela
Monoclonal anti-C5 antibody that interrupts complement cascade
Generally only indicated if plasma exchange cannot be performed immediately
Only used for life-threatening bleeding or intracranial hemorrhage under guidance from hematologist
Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death
Usually reserved for symptomatic uremia, azotemia (BUN >80 mg/dL), fluid overload or electrolyte abnormalities refractory to medical therapy
May lead to worsening lysis of bacteria and further shiga toxin release
Leads to prolonged gut exposure to toxins
Risk of toxic megacolon
Hemolytic uremic syndrome
Gastroenteritis
Sickle cell crisis
Appendicitis
Hepatorenal syndrome
Colitis
Uremic bleeding syndrome
Intussusception