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Fluid restriction does not improve the outcome of acute meningitis
S C Singhi1, P D Singhi, B Srinivas
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Fluid restriction in children with acute meningitis did not improve outcomes and may worsen them. A decrease in extracellular water (ECW) volume was associated with increased mortality and reduced survival rates.
Area of Science:
- Pediatrics
- Nephrology
- Critical Care Medicine
Background:
- Acute meningitis in children can lead to complications such as hyponatremia.
- Fluid management is a critical aspect of care for these patients.
Purpose of the Study:
- To investigate the impact of fluid restriction on body water balance and clinical outcomes in children with acute meningitis.
- To determine if fluid restriction affects total body water and extracellular water (ECW) levels.
Main Methods:
- A prospective study involving 50 children with acute meningitis, randomized into maintenance or restricted fluid groups.
- Measurements included total body water, ECW, serum/urinary electrolytes, and osmolality at baseline and 48 hours.
- Statistical analysis, including stepwise regression, was used to identify factors related to outcome.
Main Results:
- Children receiving restricted fluids showed a significant decrease in total body water and ECW.
- A reduction in ECW of 10 ml/kg or more was linked to significantly lower intact survival (36%) and higher mortality (25%).
- ECW volume at admission, ECW loss, and plasma osmolality were significant predictors of outcome.
Conclusions:
- Fluid restriction does not improve outcomes in children with acute meningitis.
- Decreased ECW volume at 48 hours is associated with an increased likelihood of adverse outcomes, including mortality.
Abstract:
The objective of this prospective study was to examine the effect of fluid restriction on body water and the outcome of children with acute meningitis. Fifty consecutively hospitalized children with acute meningitis, divided into two groups (A, without hyponatremia; and B, with hyponatremia), were randomly assigned to receive either normal maintenance (M) or restricted (R subgroup) (65 to 70% of M subgroup) fluids during the first 48 hours. Total body water, extracellular water (ECW), serum and urinary sodium and plasma and urinary osmolality were measured at admission and after 48 hours. In both groups children receiving restricted fluids showed a significant decrease in the mean total body water and ECW whereas body water remained unchanged in those on maintenance fluids. Children having an ECW reduction of 10 ml/kg or more in 48 hours had a significantly lower intact survival (10 of 28, 36%) than those with < 10 ml/kg or no reduction of ECW (15 of 22, 64%) (P < 0.05). The mortality was also higher in the former (7 of 28, 25%) than in the latter (2 of 22, 9%). On multiple stepwise regression analysis, ECW volume at admission (partial r2 0.20), ECW loss in 48 hours (partial r2 0.13) and plasma osmolality at admission (partial r2 0.22) were significantly related to outcome. We conclude that fluid restriction does not improve the outcome of acute meningitis. Indeed a decrease in ECW volume at 48 hours increases the likelihood of adverse outcome.