Twenty-seven children, ages 6 months - 13 years, with encephalopathy complicating hemolytic-uremic syndrome are reported from The University of British Columbia, Vancouver, Canada. Seventeen had seizures and 2 died. An increased risk for developing a neurological manifestation was correlated with the female sex, the prolonged use of an antimotility agent (e.g. codeine, anticholinergic drugs) and an increased hemoglobin. [1]

COMMENT. These authors have previously found an association between the prolonged use of antimotility drugs and the likelihood for progression of E coli enteritis to hemolytic-uremic syndrome. Systemically absorbed verotoxins are thought to be responsible for the multiple organ involvement. A food reservoir and improper handling are the most likely vehicles for transmission of the E coli.