A 4-year-old child with pneumococcal meningitis on appropriate antibiotics becomes drowsier on day 3. Serum sodium is 126 mEq/L, urine osmolality is high, and urine sodium is elevated; the child is euvolemic clinically. What is the most appropriate next step?

• A Give 3% saline bolus immediately
• B Increase intravenous fluids to correct dehydration
• C Restrict fluids to two-thirds maintenance ✓
• D Start furosemide

Explanation

Syndrome of inappropriate antidiuretic hormone secretion is a recognized complication of bacterial meningitis and a common cause of deterioration around day 3 to 4. The euvolemic state with concentrated urine containing sodium confirms SIADH rather than true dehydration. Management is fluid restriction to about two-thirds of maintenance until serum sodium recovers. Hypertonic saline is reserved for symptomatic severe hyponatremia with seizures, expanding fluids would worsen the dilutional hyponatremia, and furosemide has no primary role here.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.