- Refer the child to hospital if possible.
- Oral phenoxymethyl penicillin (penicillin V) 12.5 mg/kg 6 hourly or oral amoxycillin for 10 days to treat the Streptococcal infection.
- Restrict the daily fluid intake to 20 ml/kg plus the volume of the previous day’s urine output. It is important to keep a careful check on the fluid intake and output.
- Weigh daily to assess fluid status.
- Low sodium and low protein diet until the urine output increases (diuresis). Bread, jam, rice, fruit and vegetables with no added salt is a practical diet.
- Furosemide (Lasix) 1 mg/kg orally to help increase urine output
- Observe the blood pressure every 6 hours.
- Check serum urea, creatinine and electrolytes to monitor any renal failure.
Severe hypertension can be treated as an emergency with nifedipine (Adalat)
0.25 mg/kg sublingually (under the tongue). Convulsions can be stopped with rectal diazepam.
Respiratory distress due to pulmonary oedema should be managed with oxygen, furosemide 1 mg/kg intravenously, sitting the patient up and referring to hospital urgently.
Serum C3 complement is classically markedly reduced. The chest X-ray often shows an enlarged heart plus features of pulmonary oedema due to fluid retention. Serum Streptococcal antibodies are usually raised.