- Keep your suspicions high – early signs it may not be clear
- Sepsis Kills – give antibiotics & fluid early
- Consider Acyclovir
- Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
- Consider indications for CT before LP
- Get SENIOR support early
Signs & Symptoms
No single feature is diagnostic, (Get senior input)
Non-specific
- Common; Fever, Vomiting, Lethargy, Irritable, Headache, Muscular/joint pain
- Less Common; Shivers, Diarrhoea, Abdo pain, Sore throat, Coryza
More-specific
- Purpuric rash, stiff neck, Altered mental state, Photophobia, Kernigs sign
Investigations
- Bloods; Blood Culture, FBC, I-Stat (inc glucose), VBG, LFT, CRP, PCR, Clotting
- Throat swab
- LP – performed by medical team
- Opening pressure
- Microscopy
- Culture + PCR
- Protein, Glucose, Lactate
Indications for CT before LP*
- Focal neurological signs
- Papilloedema**/Pupilary changes
- Continuous or uncontrolled seizures
- GCS reduced/fluctuating
- Bradycardia & Hypertension
*to exclude significant swelling/shift predisposing to cerebral herniation post LP.
**inability to view the fundus is not a contraindication to LP, especially if a short durationof symptoms.
Regardless of CT LP should be delayed /avoided in the following situations:
- Respiratory or cardiac compromise
- Signs of severe sepsis or a rapidly evolving rash
- Infection at the site of the LP
- Coagulopathy/thrombocytopenia
Treatment – Get IMMEDIATE Senior support
- Antibiotics
- Ceftriaxone 2g IV/IO
- Over 60yrs add Amoxicillin 2g IV
- Recent foreign travel add Vancomycin
- Penicillin/Cephalosporin allergy – contact Microbiology Consultant Immediately
- Ceftriaxone 2g IV/IO
- Dexamethasone [give at same time as antibiotic]
- Consider Acyclovir 10mg/kg [use ideal body weight – see below]
- 0.9% NaCl bolus IV/IO
- Oxygen titrate to need
| Weight (kg) | Weight (st) | Aciclovir | Dexamethasone |
|---|---|---|---|
| 40 | 6st 4lb | 400mg | 6mg |
| 50 | 7st 3lb | 500mg | 7.5mg |
| 60 | 9st 6 lb | 600mg | 9mg |
| 70 | 11st | 700mg | 10mg |
| 80 | 12st 8lb | 800mg | 10mg |
| 90 | 14st 2lb | 900mg | 10mg |
| 100 | 15st 11lb | 1000mg | 10mg |
| 110 | 17st 5lb | 1100mg | 10mg |
PDF:meningitis adult
