‏ intro ‏ case ‏ background ‏ making diagnosis ‏ pathophysiology ‏ Management Principals ‏ Management Algorithm ‏ Development ‏

case1
case2
case3
case4
case5
case6
case7 case8 case9

CASE HISTORY


Diagnosis: meningococcal septicaemia.
Bloods sent for FBC, glucose, biochemistry, U&E, clotting.

15 year old  boy non-specifically unwell for a day.  Woke with a widespread purpuric rash and taken straight to hospital.

(click for larger graph)


ED assessment:
Temp 39.0, HR 120, RR 20, BP 90/60.
Alert no meningism; purpuric rash spreading.


  help

QUESTIONS ON CASE 4


     Q 4 of 18: Adequate investigations?

YesNo <correct

CORRECT : Signs of advanced septicaemia present: venous blood gas, and bloods for culture and 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).


LOOK IT UP


New01.jpg
New02.jpg
New03.jpg
New04.jpg




New05.jpg




New06.jpg
New07.jpg
New08.jpg


New09.jpg



New10.jpg




New11.jpg