FLUID RESTRICTION DOES NOT IMPROVE THE OUTCOME OF ACUTE MENINGITIS

The objective of this prospective study was to examine the effect of f luid restriction on body water and the outcome of children with acute meningitis, Fifty consecutively hospitalized children with acute menin gitis, divided into two groups (A, without hyponatremia; and B, with h yponatremia), were randomly assigned to receive either normal maintena nce (M) or restricted (R subgroup) (65 to 70% of M subgroup) fluids du ring the first 48 hours, Total body water, extracellular water (ECW), serum and urinary sodium and plasma and urinary osmolality were measur ed 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 maint enance fluids, Children having art ECW reduction of 10 ml/kg or more i n 48 hours had a significantly lower intact survival (10 of 28, 36%) t han 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 r(2) 0.20), ECW loss in 48 hours (p artial r(2) 0.13) and plasma osmolality at admission (partial r(2) 0.2 2) were significantly related to outcome, We conclude that fluid restr iction does not improve the outcome of acute meningitis, Indeed a decr ease in ECW volume at 48 hours increases the likelihood of adverse out come.