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Fluids for people with acute bacterial meningitis

Maconochie IK, Baumer J
Published Online: 
14 June 2013

Bacterial meningitis is an infection of the fluid in the spinal cord and surrounding the brain. Antibiotics are prescribed as treatment. Supportive care includes other drugs and the regulation of fluid intake. Despite treatment, there is a risk of death or long-term complications from the infection, especially in the youngest and oldest patients.

There has been disagreement as to whether fluids should be restricted (hormones secreted by very ill patients reduce normal fluid output by the body). There are potential risks from giving too much fluid (especially brain swelling) as well as too little fluid (especially shock). Three trials involving over 400 children (over 350 of which were in a single trial) were included. All trials were set in countries where death rates are high and where patients seek help late.

Analysis of available trials found no significant differences in death rates or overall effects on brain function, either immediately or later. However, one study found a significantly lower rate of seizures and spasticity (abnormal body tone) in children receiving normal amounts of fluid compared to those receiving restricted fluids.

An adverse effect in children with restricted fluid intake was that they were less likely to have low levels of sodium in their blood and therefore, they would experience greater reductions in body fluids.

An adverse effect of unrestricted fluid administration was reported in one study as short-term fluid swelling of the face and low sodium levels in the blood one to two days after fluids were started, although the largest study found no difference in sodium levels in the blood.

The review found limited evidence from these trials in support of not restricting fluids in settings with high death rates. As there were no trials in other settings, there is no evidence to guide clinicians where children present early and mortality rates are lower.