Does parenteral volume expansion improve outcomes in children infected with Escherichia coli O157:H7?

Howard Trachtman

This article has no abstract so we have provided the first paragraph of the full text.

Every discipline is plagued by a handful of perennial dilemmas: in physics it is the search for a unified field theory; in philosophy it is the mind–body problem. One of the holy grails in medicine is early diagnosis of disease. The underlying assumption is that detection of pathophysiological disturbances during the incipient stages of an illness will enable earlier therapeutic intervention and achieve better outcomes for patients. In nephrology, this quandary is well illustrated by acute renal failure. Despite impressive advances in pediatric intensive care, mortality after acute renal failure remains disappointingly high.¹ This dismal situation is played out in children with diarrhea-associated HUS. Although mortality from HUS is less than 5%, nearly 40% of patients require temporary dialysis, and up to 20% suffer chronic renal injury.² After more than 30 years' investigation of corticosteroids, fibrinolytics and oral Shiga toxin-binding biologics, no therapy has been proven to decrease the frequency of severe renal failure in diarrhea-associated HUS.³

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