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You are seeing a 2 year old who is slowly improving from a bout of acute gastroenteritis manifested by fever, vomiting, diarrhea, and abdominal pain that started 5 days ago. The parent is concerned that he remains less active and appears pale. Vital signs are temperature 37.7, HR 135, RR 24, BP 110/60, O2 sat 99% on room air. Point of care hemoglobin is 6.5 g/dL.
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June 18, 2020 at 2:49 am
E) End-stage renal failure
Hemolytic uremic syndrome from shigatoxin producing E. Coli (STEC) usually present 5-10 days after the onset of gastroenteritis symptoms from the STEC infection, which typically include fever (56%), abdominal pain, vomiting, and bloody diarrhea (50%). HUS complicates 6-9% of STEC infections. Patients develop acute renal insufficiency, hemolytic anemia, and thrombocytopenia. The patient’s blood pressure in the vignette is hypertensive for a 2 year old. Coronary artery aneurysms could complicate Kawasaki’s disease, and intussusception could complicate Henoch-Schonlein purpura, neither of which fit the vignette presented. The patient’s gastroenteritis is resolving, so dehydration and hypovolemic shock are unlikely. Anemia rarely causes high-output cardiac failure, and only when more severe.