This protocol targets a severe, high-risk presentation of hand-foot-and-mouth disease in which central nervous system involvement is accompanied by autonomic nervous system dysregulation — including hypertension — signalling imminent risk of cardiopulmonary deterioration.

Clinical Scenario

Hand, foot and mouth disease with central nervous system involvement
Autonomic nervous system (ANS) dysregulation confirmed
Resting heart rate 150–170/min (tachycardia)
Hypertension
Profuse sweating, tachypnea, or labored breathing present

Children presenting with these features of ANS dysregulation are at risk of rapid progression to cardiopulmonary failure.

Management Approach — Partial Overview

Critical care management at this stage centres on carefully guided intravenous fluid therapy, early consideration of intubation, and targeted support of cardiac function — alongside additional interventions. The complete protocol specifies the full approach, criteria, and sequence.

Full regimen, clinical decision points, and dosing guidance are available via the link below.

References

Children presenting with features of autonomic nervous system (ANS) dysregulation, including cold sweating, mottled skin, tachycardia, tachypnea, hypertension and hyperglycemia, are at risk of rapid progression to cardiopulmonary failure.
Autonomic nervous system (ANS) dysregulation: Presence of cold sweating, mottled skin, tachycardia, tachypnea, and hypertension.
Assessment of haemodynamic and hydration status should guide intravenous fluid therapy, as well as the use of inotropes to support cardiac function during this critical stage.
Early intubation is recommended, particularly for children who are restless and agitated due to frequent myoclonic jerks.
Anecdotal experience suggests that administration of milrinone at this stage may be useful in halting progression into established cardiopulmonary failure.
Anecdotal experience indicates that IVIG could also be useful at this stage.
Judicious intravenous fluid therapy.

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Treatment of Hand-Foot-and-Mouth Disease with CNS Involvement and Hypertension

Clinical Scenario

Management Approach — Partial Overview

References