Symptoms of hemorrhagic shock and encephalopathy - symptoms and signs, treatment

Hemorrhagic shock and encephalopathy syndromeHemorrhagic shock and encephalopathy syndrome



The syndrome of hemorrhagic shock and encephalopathy is extremely rare, characterized by a sharp onset in the form of severe shock, coagulopathy, encephalopathy, as well as hepatic and renal dysfunction in a previously healthy child, leading to death or catastrophic neurological consequences.


Hemorrhagic shock and encephalopathy syndrome develops mainly in children aged 3 to 8 months, however, the development of this disease in a 15-year-old child has been reported. HSES resembles a heat stroke, with an extremely high body temperature and a violation of the function of many organs, but its cause is unknown. Assume the role of excessive wrapping the child with febrile fever, but there is little evidence of this.Other theories include reaction to intestinal or environmental toxins, pancreas secretion of trypsin or non -identified viruses or bacteria. Often there are diffuse cerebral edema with hernia and local hemorrhages and infarcts in the cortex and other organs. The lungs and myocardium are not primarily affected.


Symptoms of hemorrhagic shock and encephalopathy - symptoms and signs



The prodromal period in the form of fever, upper respiratory tract symptoms or vomiting and diarrhea is observed in most patients. The main symptoms are acute onset of encephalopathy, cerebral edema and severe shock. Other common manifestations include hyperpyrexia, bloody or watery diarrhea, disseminated intravascular coagulation, myoglobinuria, and rhabdomyolysis.


Hemorrhagic shock and encephalopathy syndrome - diagnosis



Similar symptoms can occur in sepsis, Ray's syndrome and hemolytic-uremic syndrome. Patients require a laboratory examination including blood and urine culture, arterial blood gas composition, a general blood test, electrolyte level, urea, creatinine, PTV / APTT and functional liver tests.Multiple disorders include metabolic acidosis, elevation of hepatic transaminases, acute renal failure, thrombocytopenia, hematocrit fall, leukocytosis, hypoglycemia and hyperkalemia. Bacteriological and virological studies are negative. The diagnosis is a diagnosis of exclusion.


Syndrome of hemorrhagic shock and encephalopathy - prognosis treatment



In all series, more than 60% of patients die, and more than 70% of survivors develop severe neurological consequences.


The treatment is fully supportive. Infusions of large volumes of isotonic solutions and blood products simultaneously with inotropic support are necessary to maintain hemodynamics. A significant increase in body temperature requires external cooling. Increased intracranial pressure with cerebral edema requires intubation and hyperventilation. DIC often progresses, despite the use of fresh frozen plasma.

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