Pumping the Fluids to Save Kids' Kidneys

Kidney failure from E coli O157 H7 infection made less severe through intravenous fluids

(RxWiki News) It is a serious problem when a child gets infected with E. coli - a bacteria that can cause kidney failure. Now, researchers have found a way to protects children's kidneys from the bacteria.

Children who are given intravenous fluids (fluids pumped directly into the veins) early in the course of an E. coli infection may be less likely to have severe kidney failure.

"Make sure children receive IV fluids early with any E. coli infection."

Infection with E. coli - specifically a strain of the bacteria called E. coli O157:H7 - raises the risk for hemolytic uremic syndrome, the main cause of sudden, short-term kidney failure in children.

According to Christina Ahn Hickey, M.D., from Washington University School of Medicine in St. Louis and first author of the study, hemolytic uremic syndrome is like the kidneys' version of a heart attack. The goal of giving intravenous fluids to infected children, says Dr. Hickey, is to make sure the kidneys are getting enough blood flow. In other words, Hickey and colleagues are trying to keep the kidneys working so that children are still able to urinate.

If E. coli is spotted early in a child, giving that child intravenous fluids may help protect the kidney and potentially keep a child off of dialysis, says Dr. Hickey.

Dr. Hickey and colleagues came to this conclusion by studying 50 children who had been treated for diarrhea-associated hemolytic uremic syndrome.

As a result of their condition, 68 percent of these children lost the ability to urinate. Of the 25 children who did not get intravenous fluids within the the first four days of their illness, 84 percent lost the ability to urinate. In contrast, only 52 percent of those who were given intravenous fluids lost the ability to urinate.

Oral fluids are one alternative to intravenous fluids. However, oral fluids do not work as well, Dr. Hickey notes, because most children infected with E. coli are vomiting and dealing with diarrhea, making it hard to get those fluids flowing to the kidneys.

In order to make sure that the kidneys are getting enough blood flow, it is faster and better to inject those fluids directly to the blood vessels, says Hickey.

Hickey recommends that any child with bloody diarrhea should see a doctor immediately. Bloody diarrhea could be a sign of E. coli infection. Spotting that infection early may give doctors time to protect a child's kidneys.

This study - which was supported by Dr. Hickey's Doris Duke Clinical Research Fellowship - is published online in the Archives of Pediatric and Adolescent Medicine.

Review Date: 
July 25, 2011