Fifteen-minute consultation: The approach to the febrile child.

Febrile children presenting to the emergency department pose unique challenges. This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red flags and appropriate investigations. Emergency clinicians must be aware of the risk factors for SBI in febrile children, including young age, ill-appearing children and those with complex comorbidities or immunodeficiency. The presence of red flags in febrile children should immediately alert concern and prompt senior clinician review. This article also discusses the appropriate use of investigations and their role in complementing clinical assessment. When discharging children home after emergency department assessment, safety netting should be undertaken to ensure parents are aware when to seek further medical opinion. The presence of a prolonged fever of 5 days or longer should alert suspicion and usually requires further investigation.

'Diabetic ketoacidosis may not always be the answer '.

We present the interesting case of a 9-year-old boy with type 1 diabetes mellitus. He presented to the emergency department extremely unwell and the diagnosis of diabetic ketoacidosis was promptly performed. He was started on the local diabetic ketoacidosis (DKA) protocol, but his recovery remained slow. The possibility of an underlying pathology was later addressed and led to the diagnosis of primary adrenal insufficiency. This case highlights the difficulty in diagnosis of childhood Addison's disease due to its vague and non-specific symptoms and the importance of a high degree of clinical suspicion. This case also highlights the existence of autoimmune polyendocrine syndromes and the ongoing need to increase awareness and screening of these conditions.

Catatonic schizophrenia: therapeutic challenges and potentially a new role for electroconvulsive therapy?

A 36-year-old man with known schizophrenia, presented with increasingly bizarre behaviour. The development of catatonia and subsequent neuroleptic malignant syndrome in itself posed numerous therapeutic challenges. However, following resolution of neuroleptic malignant syndrome, the reintroduction of antipsychotics was not tolerated. This case report proposes a novel use for electroconvulsive therapy as a treatment of mental state, following resolution of neuroleptic malignant syndrome, to facilitate successful reintroduction of antipsychotics.