pituitrin and Meningitis--Bacterial

Topics: Africa, Eastern; Albumins; Anemia; Child; Coma; Critical Illness; Developing Countries; Dose-Response Relationship, Drug; Drug Administration Schedule; Fever; Fluid Therapy; Humans; Meningitis, Bacterial; Pneumonia; Randomized Controlled Trials as Topic; Resuscitation; Shock; Sodium Chloride; Vasopressins

Although disorders of ADH secretion associated with meningitis are usually consistent with the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), central diabetes insipidus (DI) is an exceptional complication of meningitis. Transient DI as a complication of Escherichia coli (E. coli) meningitis due to ventriculoperitoneal shunt in an 18-month-old boy is presented. Blood and spinal fluid cultures yielded E. coli, sensitive to cefotaxime. The DI arose on the day 3 after admission and continued to the day 20. Treatment comprised cefotaxime, dexamethasone, fluid adjustment and vasopressin. The course of our case supports that in cases of bacterial meningitis, initial fluid restriction may occasionally result in dangerous conditions. Therefore, all children with bacterial meningitis should be followed closely not only in terms of SIADH but also DI. To our knowledge this is the first transient DI associated with E. coli-caused meningitis case reported.

Topics: Dandy-Walker Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Humans; Infant; Male; Meningitis, Bacterial; Polyuria; Radioimmunoassay; Renal Agents; Tomography, X-Ray Computed; Vasopressins; Ventriculoperitoneal Shunt

Three patients, 11, 17 and 41 days old with various degrees of central nervous system (CNS) lesions developed central diabetes insipidus as a complication of hypothalamic damage. Two of the children had congenital CNS malformations including meningomyelocele, hydrocephalus, and prosencephaly, while the third child presented Streptococcus agalactiae meningitis, complicated with CNS hemorrhage and hypertensive dilatation of the lateral ventricles. All of them fulfilled the criteria for central diabetes insipidus, reaching high levels of serum sodium and osmolality, along with hypotonic urine. The responses to intranasal arginine-vasopressin were prompt, normalizing the serum levels of sodium and increasing urinary osmolality, allowing a better metabolic balance, avoiding continuing damage to the already compromised CNS. The neonatologist must be aware of the possibility of this kind of complication even in a normal child with CNS infection. Imaging studies showing hemorrhage in the region of the posterior hypothalamus must be a sign that this type of complication is able to occur.

Topics: Adolescent; Brain; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Vasopressins

Sixty children with acute bacterial meningitis (ABM) were prospectively studied for their serum sodium values and cerebrospinal fluid (CSF), serum and urinary osmolality. The results have been compared with 20 age and nutritionally matched controls. Even though mean serum osmolality (283.2 +/- 13.84 mOsm/kg) and serum sodium levels (130.5 +/- 8.15 mEq/L) were significantly lower in ABM in comparison to controls (p < 0.05 and < 0.001, respectively), the overall mean CSF osmolality in patients with ABM (282.5 +/- 12.3 mOsm/kg) was not significantly different as compared to controls (288.2 +/- 7.89 mOsm/kg). As expected, cases of ABM with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) had significantly lower CSF osmolality (272 +/- 9.42 mOsm/kg) as compared to those without SIADH (288.5 +/- 9.34 mOsm/kg) and controls (288.2 +/- 7.89 mOsm/kg). However, our observations indicate that whereas the mean CSF osmolality was lower than the serum osmolality in the control group as well as in ABM without SIADH, it was greater than serum osmolality in ABM with SIADH (p < 0.05). Our results suggest that in the presence of SIADH, hypo-osmolality of serum may eventually result in hypo-osmolality of CSF, but the fall in CSF osmolality is not of the same degree as that of serum. Low CSF osmolality was observed to be associated with an unfavorable prognosis (p < 0.05).

Topics: Child; Child, Preschool; Escherichia coli; Female; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Klebsiella; Male; Meningitis, Bacterial; Neisseria meningitidis; Osmolar Concentration; Prospective Studies; Sodium; Streptococcus pneumoniae; Vasopressins

Topics: Arginine Vasopressin; Fluid Therapy; Humans; Meningitis, Bacterial; Vasopressins