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CASE HISTORY


2.5 year old boy admitted with purpura and fever.


Paediatric assessment:
Temp 39.3, Pulse 134, RR 40, CRT 6 seconds, BP unrecordable, femoral pulses present but weak.
Cyanosed, Saturation 75% in air.  Widespread creps.
GCS 9/15, Neck stiffness+
Purpuric rash on chest.
Bloods sent for FBC, clotting, U&E, and culture


Diagnosis:Meningococcal meningitis.


Treatment:Antibiotics intravenously.
Fluids 40 ml/kg colloid in 2 boluses and 10 ml/kg crystalloid over 1 hour, then maintenance fluids.


Some improvement of CRT so left on the ward.


  help

QUESTIONS ON CASE 3


     Q 3 of 14: Reasonable diagnosis?

YesNo <correct

CORRECT : advanced septicaemia not meningitis
Further Information

Characteristics of meningococcal disease

The two major clinical forms of meningococcal disease are meningitis and septicaemia. Most patients will have a mixed presentation. A minority will have pure septicaemia and it is these patients who carry the worst prognosis and maximum effort must be made to identify them early12. There are important differences in the pathophysiology of meningitis and septicaemia which underlie the clinical presentation and management of the two main forms of the condition (see pathophysiology).


Disease pathway

Disease Pathway



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