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The Southern Alberta hyperhydration protocol for high-risk STEC infection is one arm of the HIKO STEC trial. It uses IV fluids at 2× maintenance to promote a high urine output state; the goal is not intentional fluid overload, although fluid accumulation can occur.
During the first 24 hours, continue hyperhydration until weight-gain targets are reached: 10% weight gain with ≥20% hematocrit reduction from baseline, or 15% total weight gain if hematocrit has not declined by 20%. If targets are not reached at 24hrs, continue 2 x maintenance IV fluids for additional 24 hrs.
Once targets are reached, adjust fluids to insensible losses + measured losses (ins/outs) to maintain high urine output.
If targets are not met after 48 hours and discharge criteria are not achieved, continue 200% maintenance fluids and reassess every 24 hrs.
Some children do not reach these targets due to increased urine output.
Monitor for complications, including pulmonary edema and hypertension. Stop the protocol only for clinically significant hypertension with evidence of target organ injury.
Most children meet discharge criteria within 2–3 days.
Discharge criteria:
- >5 days since diarrhea onset
- >24 hours since last diarrheal stool
- Platelet count increased by ≥5%
Most Recent References
Hyperhydration to Improve Kidney Outcomes in Children with Shiga Toxin-Producing E. coli Infection: a multinational embedded cluster crossover randomized trial (the HIKO STEC trial) – PMC. Freedman SB, Schnadower D, Estes M, et al. (2023) Trials 24:359.