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2. • 17 year old para 0 gravida 1 EGA ?16w
• Referral from concession hospital where she
presented with a 3 day history of headache, sore
throat and fever. Also had 1 day history of not
communicating and started fitting on arrival
• 4 episodes of seizures prior to arrival to MNMH
• Unbooked pregnacy HIV status unknown
• FBC done at concession WCC 2.7 Hb 2.4 PLT 47
MCV 67

3. Examination
• Ill patient, pale. LOC 10/15 BP 163/89 P 89 T
36.7 SpO2 95%
• ABD –HOF 18
• CHEST – clear
• CVS – unremarkable

4. Diagnosis:
1. New onset seizures ?cause
2. ?eclampsia ?meningoencephalitis rule out malaria
Plan
1. Admit c3
2. Fbc, u and e, lft, MPS, RDT, Iron studies, ESR, CRP, HIV
3. Mgso4 course
4. Ceftriaxine 1g iv bd
5. Metronidazole 500mg po tds
6. Fit chart
7. Methyl dopa 500mg po tds
8. Larmotrigine 50mg po od
9. EEG, CT brain
10. Transfuse 4 packed cells- 1 unit transfused in casualty

5. Results
• Fbc WCC 11.7 HB 11.6 PLT 183 MCV 63.6
• U and E Na 148 K 3.1 Cr 49 Ur… Cl…
• LFT AST 18 GGT 11 ALB 32 ALP 43 TBIL 17 ALT
….
• Glucometer 8.5
• Malaria parasites negative
• Serum crag negative

6. PROGRESS
• DAY 1 POST ADMISSION
o 2 episodes of fitting
o LOC 7/15
o BPs 125 to 167 on 78 to 98 P 97 to 115
o Plan to admit to ICU but no bed available

7. DAY 2 POST ADMISSION
• Critically ill patient LOC 7 on 15
• BP 106 to 136 on 67 to 80
• Hypertonia noted
• Certified dead at 1530hrs

8. Post mortem findings
Brain
• Pus on meninges R>L
• Cerebral oedema
Chest
• Pulmonary oedema
• Bilateral effusion
• Straw coloured fluid R-450ml L-150ml
Abdomen
• Hepatosplenometally
• Gravis uterus. Fetus CRL 14cm. Wt 194g
Cause of death MENINGITIS

9. DELAYS
DELAY 1
• Delay in booking pregnancy
• Delay in seeking health care after noting
symptoms
DELAY 3
• Discrepancies between Concession and
Parirenyatwa FBC
• Delay in securing ICU bed
• Delay in getting imaging (CT scan brain and EEG)

10. ICD CODE
• G03.9
• Meningitis , unspecified

11. AVOIDABLE OR UNAVOIDABLE
• AVOIDABLE