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An 11-year-old girl with dystonic cerebral palsy was brought to the emergency department. She was estimated to be at level V on the Gross Motor Function Classification System (GMFCS) and had limited verbal communication. Other coexisting medical problems were gastro-oesophageal reflux and epilepsy. She was on regular carbamazepine, domperidone and ranitidine.
Her parents gave a history of ‘agitation’ and intermittent fever for 1 week. On assessment, oxygen saturations were 86–89% in room air. She was tachycardic with a low blood pressure of 83/45 mm Hg. Tympanic temperature was 39.1°C. Blood glucose was normal as well as capillary blood gas. She looked sweaty, restless and was arching her back with intermittent flailing of all limbs. No focus for infection was apparent. High-flow oxygen and a fluid bolus were given together with empiric antibiotics. A chest X-ray was unremarkable. Blood results on admission are shown in table 1.
She continued to be pyrexial and very unsettled. At times she …
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