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.