Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client’s fluid intake because fluid overload may cause:
A. Dehydration
B. Hypovolemic shock
C. Cerebral edema
D. Heart failure
Correct Answer: C. Cerebral edema
Due to the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increased intracranial pressure. Hyponatremic solutions (e.g. 4% dextrose and one-fifth normal saline), which deliver excess free water, may worsen hyponatremia and increase the risk of cerebral edema, and have no place in the management of meningitis.
Option A: Fluid overload won’t cause dehydration. Children with meningitis require careful and regular monitoring of clinical signs of hydration state, including signs of overhydration, serum sodium, and laboratory markers of hypovolemia. Under most circumstances, any intravenous fluids given to a child with meningitis should be isonatremic e.g. Plasma-Lyte 148 or 0.9% sodium chloride (normal saline) with additional glucose.
Option B: Hypovolemic shock would occur with an extreme loss of fluid of blood. Clinical signs of shock or hypovolemia are hypotension, poor peripheral perfusion, cool pale extremities, tachycardia with low volume pulses, high blood lactate or large base deficit. Children with more than one of these signs should be given 10-20ml per kg of normal saline as a bolus.
Option D: It would be unusual for an adolescent to develop heart failure unless the overhydration is extreme. Bacterial meningitis can cause overhydration by preventing the body from eliminating fluids the way it should. This can lead to hyponatremia, an electrolyte disturbance in which the sodium concentration in the blood plasma is lower than normal.