Loose Bowels 2

A 3 year old boy presents with vomiting and bloody diarrhea for 5 days. His urine output has been markedly reduced since last night.

No other symptoms were present, and he has no comorbidities. His birth history is unremarkable and all immunizations are up to date.

Select Relevant Investigations
Complete Blood Count

Performed

WBC/DC: 7,200/mm3 (5,500-15,500)
N: 70% (23-56)
L: 30% (35-65)
Hb: 11 g/dL (11.5-15.5)
Hct: 34% (34-40)
Platelets: 50,000/mm3 (150,000-450,000)

The blood film reveals mild anemia with 1+ schistocytes, abundant reticulocytes, and marked thrombocytopenia.
Urinalysis + Renal Functions

Performed

Urinalysis:
Red Blood Cells: 20/hpf
Pus cells: Occasional/hpf
Protein: +
No cell casts

Renal Functions:
Na+: 134 mEq/l (135-145)
K+: 4.5 mEq/l (3.5-5.0)
Cl-: 97 mEq/l (95-105)
Blood Urea: 41 mg/dl (0-50)
Serum Creatinine: 2.4 mg/dl (< 1.5)
Coagulation Profile

Performed

INR: 1.0 (0.9-1.1)
PT: 12 sec (11-13.5)
APTT: 35 sec (30-50)
TT: 10 sec (10-15)
Fibrinogen: 300 mg/dL (150-400)
Stool Shiga Toxin Test

Performed

Rapid Assay Results:
Negative for Shiga Toxin 1 (stx1)
Positive for Shiga Toxin 2 (stx2)

Select Relevant Management
IV Fluids
Antibiotics
Plasma Exchange
Eculizumab