Coco Bradford

18 Jan 2022 · Coroner Andrew Cox · Cornwall and the Isles of Scilly

The coroner's concerns

1. large volume IV fluid bolus causing fluid overload
“In April 2009, NICE published CG 84 on Diarrhoea and Vomiting caused by gastroenteritis in Under 5s and management. Paragraph 1.3.3 deals with IV fluid management for patients presenting with shock. The guidance suggests rehydration with rapid IV infusion at 20mls/kg. The guidance is now a little dated and it is at odds with the Resuscitation Council UK Guidelines issued in 2021 which provide that for children and infants presenting with shock, fluid should be given in boluses of 10mls/kg -”
2. antibiotic use worsening HUS
“the administration of antibiotics may precipitate or worsen HUS and, if the child is subsequently found not to have sepsis, may inadvertently cause harm”
3. uncertainty in treating bacterial gastroenteritis with suspected sepsis
“clinical conundrum of how to treat a child with bacterial (e coli 0157) gastroenteritis who is suspected of having a concomitant sepsis”