OJPed  Vol.2 No.4 , December 2012
Are potassium levels in children with hemolytic uremic syndrome predictive of outcome?
Abstract: Objective: To ascertain the role of serum potassium levels in predicting clinical outcomes in diarrhea-associated hemolytic uremic syndrome (HUS D+). Methods: We reviewed clinical and laboratory data from HUS D+ patients at our tertiary care institution from 2001 to 2008. Serum potassium concentration at presentation and during the acute phase of acute renal failure were recorded and related to laboratory parameters and clinical outcomes. Results: 15 HUS D+ cases were identified. E. coli 0157:H7 was found in 9/15 cases (70%). Potassium levels were not predictive of clinical outcomes. Normal serum potassium levels were found in the majority of patients. Potassium levels <3.6 mmol/L were evident at presentation in 3/15 patients (23%), and no patient manifested hyperkalemia even when creatinine levels were concurrently increase. Conclusions: This study suggests the presence of vigorous compensatory mechanisms in the homoestasis of serum potassium levels during HUS D+ disease since neither the increase stool volumes associated with diarrhea nor the presence of renal failure resulted in clinically significant changes in serum potassium levels.
Cite this paper: M. Glatstein, M. , Snehal, V. , Amir Ahmad, S. and Scolnik, D. (2012) Are potassium levels in children with hemolytic uremic syndrome predictive of outcome?. Open Journal of Pediatrics, 2, 264-267. doi: 10.4236/ojped.2012.24043.

[1]   Brandt, J.R., Fouser, L.S., Watkins, S.L., Zelikovic, I., Tarr, P.I., Nazar-Stewart, V. and Avner, E.D. (1994) Escherichia coli 0157:H7-associated hemolytic uremic syndrome after ingestion of contaminated hamburgers. The Journal of Pediatrics, 125, 519-526. doi:10.1016/S0022-3476(94)70002-8

[2]   Loirat, C. (2001) Post-diarrhea hemolytic uremic syndrome. Archives of Pediatrics & Adolescent Medicine, 8, 776-784. doi:10.1016/S0929-693X(01)80196-2

[3]   Ake, J.A., Jelacic, S., Ciol, M.A., Watkins, S.L., Murray, K.F., Christie, D.L., Klein, E.J. and Tarr, P.I. (2005) Relative nephroprotection during Escherichia coli 0157:H7 infections: Association with intravenous volume expansion. The Journal of Pediatrics, 115, 673-680. doi:10.1542/peds.2004-2236

[4]   Copelovich, L. and Kaplan, B.S. (2008) The thrombotic microangiopathies. Pediatric Nephrology, 23, 1761-1767. doi:10.1007/s00467-007-0616-x

[5]   Loirat, C., Sonsino, E., Varga-Mareno, A., Pillion, G., Mercier, J.C., Beaufils, F. and Mathieu, H. (1984) Hemolytic uremic syndrome: An analysis of the natural history and prognostic features. Acta paediatrica Scandinavica, 73, 505-514. doi:10.1111/j.1651-2227.1984.tb09962.x

[6]   Gavin, P.J., Peterson, L.R. and Pasquariello, A.C. (2004) Evaluation of performance and potential clinical impact of prospect Shiga toxin escherichia coli microplate assay for detection of Shiga toxin producing E. Coli in stool samples. Journal of Clinical Microbiology, 42, 1652-1656. doi:10.1128/JCM.42.4.1652-1656.2004

[7]   Kehl, K.S., Havens, P., Behnke, C.E. and Acheson, D.W. (1997) Evaluation of the premier EHEC assay for detection of Shiga toxin-producing Escherichia coli. Journal of Clinical Microbiology, 35, 2051-2054.

[8]   Griffen, P. and Tauxe, R. (1991) The epidemiology of infections caused by Escherichia coli 0157:H7, other enterohemorrhagic E coli and the associated hemolytic uremic syndrome. Epidemiologic Reviews, 13, 60-98.

[9]   Rosenfield, A.T. and Siegel, N.K. (1981) Renal parenchymal disease: Histopathologicsonographic correlation. American Journal of Roentgenology, 137, 793-798.

[10]   Trompeter, R.S., Schwartz, R., Chantler, C., Dillon, M.J., Haycock, G.B., Kay, R. and Barratt, T.M. (1983) Haemolytic uremic syndrome: An analysis of prognostic feature. Archives of Disease in Childhood, 58, 101-105. doi:10.1136/adc.58.2.101

[11]   Scheiring, J., Rosales, A. and Zimmerhackl, L.B. (2010) Clinical practice. Today’s understanding of the haemolytic uraemic syndrome. European Journal of Pediatrics, 169, 7-13. doi:10.1007/s00431-009-1039-4

[12]   Nestoridi, E., Kushak, R.I., Tsukurov, O., Grabowski, E.F. and Ingelfinger, J.R. (2008) Role of the renin angiotensin system in TNF-alpha and Shiga-toxin-induced tissue factor expression. Pediatric Nephrology, 23, 221-231. doi:10.1007/s00467-007-0636-6

[13]   Shah, G.S., Das, B.K., Kumar, S., Singh, M.K. and Bhandari, G.P. (2007) Acid base and electrolyte disturbance in diarrhoea. Kathmandu University Medical Journal, 5, 60-62.

[14]   Gennari, F.J. (2002) Disorders of potassium homeostasis. Hypokalemia and hyperkalemia. Critical Care Clinics, 18, 273-288. doi:10.1016/S0749-0704(01)00009-4

[15]   Mandal, A.K. (1997) Hypokalemia and hyperkalemia. Medical Clinics of North America, 81, 611-639. doi:10.1016/S0025-7125(05)70536-8

[16]   Glatstein, M., Miller, E., Garcia-Bournissen, F. and Scolnik, D. (2010) Timing and utility of ultrasound in diarrhea-associated hemolytic uremic syndrome: 7-year experience of a large tertiary care hospital. Clinical Pediatrics, 49, 418-421. doi:10.1177/0009922809342582