A 2 year old child with rash and fever

Elisabeth first became unwell during the evening of her 2nd birthday. Her parents noticed that she was “grizzly and off her food.” Later that night she woke with a temperature of 38.9°C. During the next two days her fever, lethargy, and irritability persisted despite regular paracetamol. Her fluid intake was poor. On the second evening her mother noticed that Elisabeth was very thirsty but cried whenever she put a cup to her mouth. Her tongue was brick red, furrowed, dry, …