QJM Advance Access originally published online on December 17, 2006
QJM 2007 100(1):37-40; doi:10.1093/qjmed/hcl131
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Hyponatraemia in adults with community-acquired bacterial meningitis
From the Departments of 1Neurology, 2Medical Microbiology and 3The Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Address correspondence to Dr M. Brouwer, Department of Neurology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. email: m.c.brouwer{at}amc.uva.nl
Received 25 July 2006 and in revised form 24 August 2006
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Abstract |
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Background: Hyponatraemia in adults with bacterial meningitis has been described as a common complication, but its true prevalence and clinical importance are unknown.
Aim: To investigate the prevalence, clinical characteristics and consequences of hyponatraemia in bacterial meningitis in adults.
Design: Nationwide observational cohort study.
Methods: We prospectively assessed the prevalence and clinical characteristics of hyponatraemia among 696 adults with community-acquired bacterial meningitis. Symptoms and signs on admission, blood and CSF test results, radiological examinations and complications during admission were recorded.
Results: Sodium levels were determined at admission in 685/696 episodes of bacterial meningitis (98%). Hyponatraemia (<135 mmol/l) was seen in 208/685 (30%) and was classified as severe (<130 mmol/l) in 38 (6%). Hyponatraemia developed during admission in an additional 53 episodes. Hyponatraemia was not associated with an increase in symptoms, with complications or with unfavourable outcome. Treatment for hyponatraemia was initiated in 16% of episodes, but did not influence its duration.
Discussion: Hyponatraemia appears both common and benign in adults with bacterial meningitis. In cases of severe hyponatraemia, we suggest the use of fluid maintenance therapy.