THE Worcestershire Acute Hospitals NHS Trust said lessons will be learned from the death of Redditch boy Callum Cartlidge, after a coroner said not carrying out a simple blood test was a "serious failing" which would have saved his life.

Callum Cartlidge died after suffering a cardiac arrest on March 3 last year, less than 24 hours after initially being discharged from the Worcestershire Royal Hospital with a diagnosis of gastroenteritis.

The eight-year-old, who was having an undiagnosed adrenal Addisonian crisis linked to the rare condition Addison's Disease, was sent home from hospital with Dioralyte rehydration salts.

At Worcestershire Coroner’s Court earlier today, assistant coroner David Reid described the decision to discharge him without carrying blood tests as a “serious failure”.

His parents Adie and Stacey said they feel "concerns regarding Callum’s condition were not taken seriously".

The Trust has changed procedures as a result of the case, including regularly updating a fluid chart which was "inadequately" filled in, causing confusion over the intake of fluid Callum received.

Dr Andrew Short, divisional medical director for women and children’s services at Worcestershire Acute Hospitals NHS Trust, added they will "learn from his death for the benefit of patients in the future".

He said: “We would like to again express our deepest condolences to Mr and Mrs Cartlidge for the tragic loss of their son Callum and apologise for the failures described by the coroner.

“This has been an extremely distressing case for everyone it has touched, in particular Callum’s family but also our staff and other healthcare professionals who were involved in his care.

“Callum died after a viral infection triggered the sudden and unexpected onset of an extremely rare and undiagnosed condition.

“The inquest heard from a leading expert on that condition, Addison’s Disease, who said he had never before in his 25-year career seen the disease present in the way it did in Callum.

“Doctors and nurses who dedicate their careers to the care of children rely on their skills, knowledge and experience to interpret a range of clinical signs and observations of the child in front of them to decide on the best course of treatment.

“Sometimes, despite our best intentions, the outcome is not what we anticipated.

“The coroner recognised that we have carried out our own thorough review of what happened to Callum to make sure that we learn from his death for the benefit of patients in the future.

“We have improved record keeping and documentation on our children’s ward, and the quality of records including fluid charts, is regularly audited.

“These audits have shown a significant improvement over the past few months.

“We have also shared our learning on Addison’s Disease with colleagues and put in place new processes to allow ambulance crews, GPs and other health professionals to refer children in need of urgent attention directly to our children’s ward.

“We will continue to reflect and learn from the coroner’s findings.”