Departamento de Urgencias, Hospital de Niños "Ricardo Gutiérrez" de Buenos Aires, Argentina.
Servicio de Nefrología, Hospital de Niños "Ricardo Gutiérrez" de Buenos Aires, Argentina.
Arch Argent Pediatr. 2021 Feb;119(1):62-66. doi: 10.5546/aap.2021.eng.62.
Diarrhea-associated hemolytic uremic syndrome is preceded by gastroenteritis due to Shiga toxin-producing Escherichia coli. Support measures are recommended, specifically, fluid restriction to avoid cardiopulmonary overload. However, in the prodromal period or with established hemolytic uremic syndrome, volume expansion with isotonic fluids is safe and effective, and reduces the need for dialysis, the length of hospital and intensive care stay, neurological events, and hyponatremia. Therefore, when nephrological monitoring is available and/or short-term access to a tertiary care hospital is guaranteed, it is suggested to hydrate patients with no signs of cardiopulmonary overload, regardless of their renal function, with initial volume expansion. Afterwards, if an adequate urine output is achieved, the patient should not be dialyzed (except if they have a medically intractable metabolic/electrolyte disorder) and hydration should be continued with an isotonic solution containing 5 % dextrose for adequate hydration and urine output.
腹泻相关性溶血尿毒综合征由产志贺毒素大肠埃希菌引起的肠胃炎引发。推荐支持治疗，具体来说，限制液体摄入以避免心肺过载。然而，在前驱期或已确诊溶血尿毒综合征的情况下，用等渗液进行容量扩张是安全有效的，可减少透析需求、住院和重症监护时间、神经事件和低钠血症的发生。因此，当具备肾脏科监测条件和/或能保证短期转至三级护理医院时，建议对无心肺过载迹象的患者进行补液，无论其肾功能如何，先进行初始容量扩张。之后，如果达到足够的尿量，患者不应进行透析（除非存在医学上无法处理的代谢/电解质紊乱），应继续用含 5%葡萄糖的等渗溶液进行补液，以保持充足的液体摄入和尿量。
