Fluid management in Haemophilus influenzae meningitis

The fluid management of 50 children with Haemohpilus influenzae type B meningitis was reviewed. Clinical hydration status on admission, serum sodium values, and overall fluid balance was assessed to determine the contribution of empiric fluid restriction in preventing the development of syndrome of inappropriate antidiuretic hormone (SIADH). Thirty-three of 50 patients were well hydrated on admission. Sixteen of 50 patients (32%) initially had signs of dehydration and five out of 16 were in shock. Only two patients had evidence of SIADH. Twenty patients were empirically fluid restricted, including one who proceeded to develop SIADH; thirteen were not fluid restricted, and sixteen who were dehydrated received replacement fluids in addition to the usual maintenance fluids. None of these patients developed SIADH. As fluid depletion was more common than excessive fluid retention in our patients, empiric fluid restrictions could not be justified. Careful, individualized monitoring of the clinical state of hydration, electrolytes and osmolaities is suggested to guide the fluid management in these patients.