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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 4 of 14: Adequate investigations?

Yes <incorrectNo

INCORRECT : Signs of advanced septicaemic shock present: venous blood gas, biochemistry, glucose and blood for meningococcal PCR should have been done.
Further Information

Initial laboratory assessment

The tests below should be done on all suspected cases of MD and children who are suspected of having an invasive bacterial infection:

  • Glucose
  • Full blood count
  • Electrolytes and urea
  • Calcium and magnesium ( metabolic derangements are common in septicaemia and may contribute to myocardial dysfunction)
  • Phosphate
  • Clotting studies
  • Venous blood gas to measure base excess
  • Blood culture
  • Throat swab culture
  • Meningococcal PCR whole blood (EDTA specimen) to send to reference laboratory

Parameter Normal range*
Hb 10.5 to 13.5 g/dL
WCC 5.0 to 15.0 (×109)
Platelets 150 to 450 (×109)
Base Excess 0 to -3 mmol/L
pH 7.35 to 7.45
HCO3 22 to 26 mmol/L
PaO2 10 to 13.5kPa or 75 to 100mmHg
PaCO2 4.6 to 6kPa or 34.5 to 45 mmHg
Glucose 3.6-5.2 mmol/L
Urea 2.5 to 6.0 mmol/L
Creatinine 19 to 43 mmol/L
Na 133 to 146 mmol/L
K+ 3.5 to 5.5mmol/l
Mg++ 0.66 to 1.0 mmol/L
Total Calcium 2.17 to 2.44 mmol/L
PO4 1.60-2.90 mmol/l
INR 1
PT 9.9 to 12.5 seconds
APTT 26.0 to 38.0 seconds
TT 9.2 to 15.0 seconds
Fibrinogen 1.7 to 4.0 g/L

*Please note that normal ranges for many variables can differ among hospitals.

Blood gas reports measurement of base excess (BE), which, when negative indicates that there is a base deficit (acidosis).


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