Abstract
A 2-month-old baby with known hypoplastic left heart syndrome presents to the paediatric emergency department from home with a history of poor oral feeds and lethargy. The parents describe the baby having had profuse watery diarrhoea and non-bilious vomiting over the last 24 hours. Urine output has been reduced to about half the usual amount according to the family. The patient is on 12 hourly furosemide and spironolactone (each at 1 mg/kg/dose), 8 hourly captopril (0.3 mg/kg/dose) and aspirin (5 mg/kg/daily). On examination, the baby is clubbed and cyanosed with a sternotomy scar and a loud continuous murmur at the right upper sternal border radiating to the back. The anterior fontanel is slightly sunken. The abdomen is soft and non-tender with active but normal pitched bowel sounds.
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