A patient with Shiga toxin-associated hemolytic uremic syndrome who developed hyperkalemia in the recovery period

Abstract

We report an 11-year-old girl who presented with episodes of hyperkalemia during the period of recovery, from hemolytic uremic syndrome (HUS) induced by Shiga toxin-producing Escherichia coli. She developed moderate azotemia but continued to pass urine. However, hyperkalemia was observed on days 11 and 25 of clinical course, although hemolysis and renal insufficiency had recovered by that time. Nafamostat mesilate (NM), continuously infused to relieve thrombotic microangiopathy, may have elevated serum potassium level by decreasing urinary potassium excretion. However, a direct effect of Shiga toxin on distal nephron segments was also suggested. Hyperkalemia should be considered in patients with Shiga toxin-associated HUS, not only in the acute phase but also in the recovery period.