After initial improvement for few hours, Amina started to deteriorate again with headaches, slow heart rate followed by irritability and confusion. Her BM was 16.5 at the time. Cerebral oedema is now suspected:
Mannitol 0.5 g/kg stat (= 2.5 ml/kg Mannitol 20% over 15 minutes). This needs to be given as soon as possible.
Restrict IV fluids to 2/3 maintenance and replace deficit over 72 rather than 24 hours.
The child will need to be moved to ICU (if not there already).
Intracerebral pressure monitoring may be required.
Repeated doses of Mannitol (above dose every 6 hours) should be used to control intracranial pressure.