A 4-year-old girl was diagnosed with “Minimal Change Nephrotic Syndrome”. She responded to steroids and after completing six weeks of daily therapy she was on an alternate day early morning prednisolone 1.5 mg/kg. As she was tolerating treatment without any complications she was sent home. She had low-grade fever associated with a small abscess, back .was put on oral antibiotics from the local hospital. After two bouts of vomiting she became sick and drowsy she was refback.
At the time of admission her peripheries were cold, capillary filling time 4 seconds, breathing was acidotic and she was drowsy. First possibility considered was septic shock normal saline bolus was given after collecting blood samples. She did nt respond to three boluses of 20 ml per kg. As she was on high dose steroids for more than two months and had vomiting, one bolus of hydrocortisone 10 mg/kg was given…
