Its the 16th February 2004, its 23.00.

You have had a busy evening. If you found your way here, your patient is still alive.

Keys to keeping the child alive in hospital are appropriate resuscitation and then management of the convulsion. Then Sarah Jane needs investigation and treatment of the meningitis that she probably has.

Investigation at this stage should include a CRP and white count (may be high or low, strongly suggesting infection. Platelets may be low too if there is DIC. Urea and electrolytes are unlikely to help at this stage, although the sodium may be low due to SIADH if there is meningitis.

Blood cultures could provide an organism, or even urine cultures. You can also look for specific antigens in the urine (meningococcus or pneumococcus).

Really you want to do an LP. Not a great move at the moment. I suggest reviewing the child in the morning.

Well done. Now for a real child!