A young classroom assistant who passed away in Altnagelvin Hospital died from multi-organ failure brought on by a rare flu complication that caused her muscles to break down, an inquest into her death found.
Shauna McSorley (20) from Dungiven had been out walking the family dog on a beach with her father on New Year's Eve 2017 when she complained of feeling unwell with flu-like symptoms and vomiting and diarrhoea.
Ms McSorley continued to feel unwell, but when her lips turned blue and her "eyes rolled to the back of her head" on January 3, 2018 her mother called for an ambulance and she was admitted to Altnagelvin Hospital's Emergency Department (ED).
Medical staff quickly became concerned about Ms McSorley when they were unable to record her blood pressure because it was so low.
One of the blood tests carried out showed a creatine kinase (CK) reading of 22,000 - the normal level should be between 20 and 200. Muscle cells need CK to function.
Medics suspecting sepsis and rhabdomyolysis - a condition in which damaged skeletal muscle breaks down rapidly - among possible diagnoses treated Ms McSorley with a cocktail of antibiotics and high levels of fluids and dialysis in the intensive care unit where she had been transferred shortly after admission.
Intensive care consultant Dr Lynn Gilfeather told the inquest sitting in Londonderry that Ms McSorley had come into hospital "very ill" and she failed to respond to any treatment, including steroids.
Two days after admission, Ms McSorley, who had been able to talk, "took a turn" and a decision was made to place her on life support when her organs began to fail.
Dr Gilfeather explained that while they wanted to carry out an MRI scan on Ms McSorley, she was "too unwell" to be moved to a different part of the hospital.
Coroner Joe McCrisken, who asked Dr Gilfeather why Ms McSorley hadn't been moved to the Royal Victoria Hospital in Belfast, was told that even if Ms McSorley had been fit enough to be moved the treatment in Belfast for rhabdomyolysis was exactly the same.
Another intensive care consultant, Dr Manav Bhavsar, said the medics recognised her body was in shock but that they didn't know if the cause was septic shock, cardiac shock or some other form.
Ms McSorley's organs began to "dis-function" and by January 10 her condition was described by Dr Bhavsar as "extremely grave" and the decision was taken by the doctors after consulting with Ms McSorley's parents to switch off life support.
The inquest heard that although Ms McSorley did not present with symptom typical of influenza in the ED, after discussing her condition with a specialist microbiologist it was suggested to test for influenza on January 8.
Results of this showed Ms McSorley had influenza A and B even though she did not have classic symptoms of a chest infection.
The inquest heard that the diagnosis of flu at this stage made no difference to the tragic outcome because Ms McSorley was critically ill when she came into the hospital five days earlier.
Consultant pathologist Dr Conall McAughey told the inquest that during the winter of 2017/18 in Northern Ireland, 119 people had been admitted to intensive care units with the flu.
Of these, 22 patients had died.
Dr McAughey said 60 of the 119 people did not fall into the category for free flu vaccine and that "although this is the tragic death of a young girl, influenza does kill people every year".
The pathologist also explained that rhabdomyolysis is a "rare but recognised complication of influenza".
Dr Estelle Healy, who performed an autopsy on Ms McSorley, said when she compiled her initial report she said the cause of death was "unascertained" because the results of all the tests carried out would not be known until some time after.
She explained in March when she had all the results she reported Ms McSorley's primary cause of death was influenza adding "if there had been no influenza, there would have been no rhabdomyolysis" which led to multi-organ failure.
She also said by the time Ms McSorley was admitted to the ED at Altnagelvin this was already well established, as indicated by the CK reading of 22,000.
In his findings, Mr McCrisken said he knew Ms McSorley's mother couldn't understand why a fit and healthy young woman could die from the flu.
But he explained that in the same year, among the 21 other people in Northern Ireland who died from influenza were four other young people.
These were a nine-year-old, a 12-year-old and two 18-year-olds.
He found that Ms McSorley died from multi-organ failure cause by rhabdomyolysis brought on by influenza.
Mr McCrisken told the inquest that he "was satisfied" Ms McSorley received "appropriate treatment at all times" and died "in spite of intense action" taken to save her life.