J Korean Pediatr Soc.  2000 Jun;43(6):814-819.

Hemorrhagic Shock and Encephalopathy Syndrome as a Cause of Sudden Death in Infants

• Lee JW
• Lee CH
• Chung KS

Abstract

PURPOSE: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome.
METHODS
We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed.
RESULTS
The age of onset was 1.0+/-0.9 years and the male to female ratio was 1: 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2+/-2.1g/dL, BUN 35.7+/-24.0mg/dL, creatinine 1.9+/-1.5mg/dL, AST 561.0+/-1,412.1IU/L, ALT 858.9+/-1,649.8IU/L, blood glucose 229.5+/-197.4mg/dL, ammonia 195.4+/-129.7pg/dL, and total bilirubin 4.9+/-8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%.
CONCLUSION
We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy. (J Korean Pediatr Soc 2000;43:814-819)

Keyword

Hemorrhagic shock and encephalopathy(HSE) syndrome; Disseminated intravascular

MeSH Terms

Age of Onset
Ammonia
Bilirubin
Blood Glucose
Creatinine
Dacarbazine
Death, Sudden*
Dehydration
Diarrhea
Edema
Female
Fever
Hemorrhage
Hepatic Encephalopathy
Hepatomegaly
Herpesvirus 4, Human
Humans
Infant*
Male
Mortality
Pediatrics
Prognosis
Renal Insufficiency
Respiratory Insufficiency
Rotavirus
Seizures
Serologic Tests
Shock
Shock, Hemorrhagic*
Splenomegaly
Vomiting
Ammonia
Bilirubin
Blood Glucose
Creatinine
Dacarbazine