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CASE HISTORY
Two hours after admission:
P178, BP 112/60 RR 46.
Increasing rash, drowsy, some response to parents.
No urine output.
Results:
WCC 3.2, INR 2.2,Urea 8.3.
Hb 9.5, Pl 60, Na 132 K 3 Urea 8.3 Creatinine 100
Chest X-ray shows pulmonary oedema.
Frusemide given and fluids slowed down. The child has had a total of 80mls/kg by now.
SHO review: very fast tachycardia, ? need blood gas, ? needs LP.
Six hours after admission:
HR 194, not recognising parents. Doctor reviewed child, advised that Mannitol infusion be considered if further decrease CNS. 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.
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QUESTIONS ON CASE 3
Q 5 of 14: Features of severe disease present?
YesNo
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