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October 1990

The 'H' in Hemorrhagic Shock and Encephalopathy Syndrome Should Be 'Hyperpyrexia'

Author Affiliations

Department of Pediatrics University of Arizona Health Sciences Center 1501 N Campbell Tucson, AZ 85724

Am J Dis Child. 1990;144(10):1077. doi:10.1001/archpedi.1990.02150340021016

It is unfortunate that this syndrome is titled hemorrhagic shock and encephalopathy (HSE). This gives the clinician the impression that the shock is caused by hemorrhage such as that seen in patients with acute blood loss due to massive trauma, peptic ulcer disease, esophageal varices, a ruptured aorta, and so forth. Although hemorrhage is a component of this syndrome, the published reports indicate that the bleeding is seen with and, more commonly, later in the shock stage. These patients do not hemorrhage first, then proceed into hypovolemic shock. Rather, the bleeding is See also p 1079. either part of the syndrome or secondary to the consumption coagulopathy that occurs in all shock states. Although the coagulopathy appears to be due to disseminated intravascular coagulation (DIC) in HSE, the hematologic data are incomplete.1,2

In classic DIC, the laboratory findings are thrombocytopenia; reduced factors II, V, and VIII; hypofibrinogenemia; and positive