A boy with fever, shock and coma
A previously well 12-year-old boy presented with a one-day history of vomiting, fever, and headache.
On examination, he was tachycardic and poorly perfused. He had left-sided ptosis and a dilated non-reactive left pupil, and his Glasgow coma score was 8. He had hyponatraemia (Na 129mmol/L; normal 135-145mmol/L), normal potassium, normal glucose, leucocytosis, neutrophilia, and raised CRP (305mg/L; normal <5mg/L).
Our working diagnosis was infective meningo-encephalitis with cerebral oedema, so he was intubated and given intravenous 3%