Hemolytic Uremic Syndrome in Emergency Medicine Clinical Presentation

Updated: Jun 24, 2021
  • Author: Audrey J Tan, DO; Chief Editor: Steven C Dronen, MD, FAAEM  more...
  • Print
Presentation

History

The presentation in patients with hemolytic uremic syndrome (HUS) may vary with the etiology. Typical HUS (ie, Shiga toxin–related) presents as follows:

  • Recent history may include such risk factors as eating rare hamburger, a trip to a petting zoo, or contact with persons with diarrhea
  • Diarrhea, which becomes hemorrhagic in 70% of cases, usually within 1-2 days
  • Vomiting, in 30-60% of cases
  • Fever, in 5-20% of cases
  • After 4-6 days, sudden onset of the clinical manifestations of HUS: pallor and shortness of breath from hemolytic anemia, and reduced or absent urine output due to acute kidney injury
  • Neurologic symptoms in 33% of patients (eg, irritability, seizures, or altered mental status)
  • Diarrhea may improve as the other HUS signs and symptoms begin 

Atypical HUS does not typically begin with a gastrointestinal (GI) illness. Patients with pneumococcal HUS may have had a recent respiratory illness. Clinical manifestations of atypical HUS are similar to those of typical HUS, although neurologic involvement is more common.

Next:

Physical Examination

Findings in patients with hemolytic uremic syndrome reflect those of the inciting prodromal illness and the end organ in which thrombogenesis is occurring, as follows:

  • Gastrointestinal: GI bleeding is often noted. GI involvement may lead to symptoms of an acute abdomen, with occasional peritonitis.
  • Cardiac involvement may lead to congestive heart failure (CHF) and arrhythmias.
  • Microinfarcts in the pancreas may cause pancreatitis or rarely, insulin-dependent diabetes mellitus.
  • Ocular involvement may lead to retinal or vitreous hemorrhages.
  • Hypertension and oliguria are typical findings consistent with renal compromise.
Previous