The sodium concentration was low at 126 mmol/l
(132±142 mmol/l) and the potassium serum concentration was high at 5.5 mmol/l
(3.4±5.0 mmol/l). The patient was started on penicillin-G 0.5 MU i.v. six hourly
plus intravenous ¯uids as well as frusemide 20 mg stat then 10 mg eight hourly.
On day 5, the patient was still looking unwell but was passing urine with some
blood still evident. Urinalysis on day 5 showed red blood cell (3+), proteins (2+)
and traces of urobilinogen, bilirubin, ketones and no glucose. The child was noted
to have been mumbling a lot during the night.