FEATURES
- Headache
- Change in neurological status
- Specific neurological signs
- Increasing BP, slowing pulse
- Papilloedema
MANAGEMENT:
- URGENT transfer to a PICU.
- Elevate head end of bed by 30 degrees( Neck straight)
- Check Blood glucose.
- 3% saline (2-5ml/kg over 30 minutes). Maintain serum osmolarity <360 mOsm/L
- Mannitol 0.25 g/kg to 1 g/kg( Max 12.5gm) stat over 20 min.
- Hyperventilation (Paco2 between 30-35mm Hg).
- Restrict IV fluids to 1/2 maintenance and replace deficit over 72 (rather than 24 hours).
- Consider repeating a dose of Mannitol (0.5 g/kg) after 2 hours