Thank you for attending and making today’s session so lively and interesting.

We discussed a scenario in which a 21 day old baby presented with lethargy, poor feeding and weight loss. Serum Na: 110 mmol/l. Ankita was the role player and Anurag took the hot seat. The history and communication were appropriate. Consanguinity needs to be confirmed if there is suggestion of a recessive condition.

The differential diagnosis could be done better and appropriate management can only be correct if our differential diagnosis is on track.

Learning points:

• In a neonate with lethargy and poor feeding NEVER forget sepsis
• Differential diagnosis should be most likely first
• If results or information suggests a life threatening condition – MANAGE that first
• In this child sepsis and hyponatremia have to be priority in treatment
• Frequency of medications – can make an educated guess and ask for confirmation.
• Is it drug x – Hydrocortisone and other – Fludrocortisone
• Role player is likely to clarify even if they have not given the name on drugs first
• Investigations to support or rule out your differential
• Discuss with your consultant

If there are points I have missed or comments you wish to add.
Anil Garg