Aqute B.M Elevated (100-300) 100-1000 or more 100-500 <40 OR <50%
PMNS Serum Glucose
Viral M.N Normal or slightly Rarely >1000 pmns 50-200 Normal or dec:
Elevated b/t mononuclear
T.B, M.N Elevated 10-500 PMNS early 100-3000 <50
b/t Lymphocytes may be high
Fungal M.N Elevated 5-500 PMNS early 25-500 <50
b/t mononuclear late
Sphilis Elevated 50-500 lymphosytes 50-200 Normal
Amebic M.N Elevated 1000-10000 PMNS 50-500 Normal or Dec
Plan of Treatment
Acute menengitis is always medical emergency and should dictete immediate management. All children with altered state of consciousness should observe closely
Assessment of child who is vitaly stable frequently first 72 hour consist of
Early sign of CNS
(level of consciousness, pupilary reflex, motor strength, cranial nerve sign, development of seizure etc)
Changes in vital sign (pulse, B.P, R.rate)
Development of SIADH
Assessment of child with rapidly progressive diseases of less than 24 hour patient is in profound coma or whose detoriate level of consciousness should evaluated for complication
Multiple organ failure
Therapy that are crucial for all patient with B.M
Maintain IV line
pass NG tube
2.Anti microbial therapy
3.Anti inflammatory therapy
4.Anti convulsant therapy
If pt is half to two normovolumic normal BP IV fluid should be restricted to one third of maintenenceor 800,1000ml/m2/24hr
- To minimize brain edema and prevent SIADH with has been reported in 29 to 88% of B.m
2. Fluid restriction is not appropriate in the presence of systemic hypotension b/c reduce BP may result in reduced cerebral perfusion pressure and CNS ischemia. Therefore shock must be treated aggressively to prevent Brain and other Organ dis-function (ATN, Acute respiratory distress syndrome.
3. Fluid Administration may be returned to normal 1500 – 1700 ml/ m2/24 hours, When S.NA level are normal.
4. Patient with septic shock may required fluid resuscitation and with Vaso constrictive agent such as Dopamine and Epinephrine.
5. Patient with shock and Markedly Elevated ICP, coma and refractory Seizure require central Arterials monitoring and Venous acess and Pediatric ICU care.
6. S.NA concentration should be closely monitor every 4-6 hours during ist 24 hours of Therapy –
- If S.NA level decrees to <125 mEq/L this should repeat as soon as possible
-If S.NA level is still <125 mEq/L fluid should be restricted to keep Vein open until S.Electrolyte concentration have been corrected.
- For B.M providing routine maintenance fluid at approximately 80% of maintenance rate after fluid repletion and advancing to full maintenance rate as S.NA increased >135 mEq/L seem to be appropriate.
7. The period of fluid restriction may only need to be <1 day.
Anti Microbial Therapy:-
Initial (empirical) choice of therapy based on age B/C of causative agent is present at the time of diagnoses.
Adjustment of therapy can be made as Vaccination history and result of CSF culture are confirmed.