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Save the life of an infant with hemolytic uremic syndrome

Recently, City Children’s Hospital received a child Ng. MN 10 months old female, living in Vinh Chau, Soc Trang. Take the medical history recorded for the child who was sick for 6 days N1-N3: the child had a fever, shivering with watery diarrhea 3-4 times a day, and was admitted to a hospital in the city. N4-N6: child still has fever, cough, loose stools 5-6 times/day, no blood sputum, is treated with fluids, antibiotics, the child’s condition does not decrease, leg edema appears, face edema, little urine, increased weight from 7.2 kg to 8.6 kg, should be transferred to City Children’s Hospital. Here, through examination, the child had a fever of 38.5 degrees Celsius, lethargy, lethargy, rapid breathing, regular heart, less moist rales, tender abdomen, general edema, bruises on the skin. Blood tests show that the child has an infection with an elevated white blood cell count of 18500/microL (normally at this age about 8000-12000/microL), the majority of polymorphonuclear leukocytes predominate 87%, CRP is elevated. 96 mg/L (normal < 5 mg/L). Children with metabolic acidosis, high blood lactate, especially impaired renal function, blood urea nitrogen 10.6mmol/L (normal 2.5-5mmol/L), blood creatinine increased 132 micromol/L (normal in children) At this age, blood creatinine < 35.4 micromol/L), peripheral blood smear shows red blood cell debris, demonstrating hemolysis and platelets decreased to 32000/microL (normal 150000-40000/microL). Children were diagnosed: sepsis from the gastrointestinal tract, pneumonia, acute kidney injury – hemolytic uremic syndrome, receiving oxygen-respiratory support, broad-spectrum antibiotics, electrolyte correction, using diuretic use. The child's condition did not improve, blood creatinine continued to rise, urine was less, anuria, respiratory failure, generalized edema, high blood pressure, acute pulmonary edema, intubation was performed to help with breathing, mechanical ventilation, and filtration. Continuous blood transfusion, transfusion of blood and blood products, infusion of nifedipine to control high blood pressure, continued electrolyte adjustment, fluid balance to reduce systemic edema, acute pulmonary edema. Results after nearly 1 month of treatment, the child's condition gradually improved, with urine gradually increasing from oliguria 0.2ml/kh/hour to polyuria >2ml/kg/hour, the child was weaned from the ventilator, sober, fed rather. This is a rare hemolytic Uremic Syndrome in children, accounting for 3/100,000 children under 5 years of age, manifested by hemolysis (broken red blood cells), thrombocytopenia, and acute kidney injury. Possible causes are primary: complement dysfunction such as genetic mutations (C3, coagulation-related factors), autoantibodies against complement H, congenital disorders of cobalamine C metabolism, but often secondary to an infection caused by Shiga toxin-producing E coli (Shiga toxin-producing E. coli – STEC, E coli O157:H7), or Shigella, Salmonella, or Streptococcus pneumoniae bacteria. Parents should note that when their children have fever, diarrhea, vomiting, swelling of eyes, face, hands and feet, whole body, little urine, accompanied by bruising, watch out for children with this syndrome, they should take them to a medical facility. have a pediatric specialist for appropriate examination, diagnosis and treatment.

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Young Ng.  MN 10 months old, female, diagnosed with hemolytic uremic syndrome, high blood pressure, acute pulmonary edema, acute renal failure, receiving respiratory support, continuous dialysis.
Young Ng. MN 10 months old, female, diagnosed with hemolytic uremic syndrome, high blood pressure, acute pulmonary edema, acute renal failure, receiving respiratory support, continuous dialysis.
After nearly a month of treatment, the child gradually recovered, urinated well, breathed fresh air, was alert, and fed well.
After nearly a month of treatment, the child gradually recovered, urinated well, breathed fresh air, was alert, and fed well.

Doctor of CSII Nguyen Minh Tien
City Children’s Hospital

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