So all day I’ve been agonizing about whether it is ok to discharge a patient in whom aseptic meningitis is suspected. The first article I found said that if the CSF is abnormal in any way, you need to admit for 48 hrs because bacterial meningitis CSF studies may resemble viral meningitis in the early stages or if the patient had been partially treated.

But then there is this paragraph from emedicine:

Although most patients with signs of meningitis are hospitalized, a subgroup with aseptic meningitis are treated appropriately in an ambulatory setting. Absolute criteria for discharge of these patients from the emergency department (ED) have not been established, but recent investigations in children suggest that age > 1 year, nontoxic clinical appearance, normal serum WBC count, mild CSF pleocytosis, negative CSF Gram stain, adequate control of symptoms, and a reliable family setting may serve as some useful factors in the decision to discharge. Prospective studies would aid in further delineating guidelines for patient discharge and follow-up. Most admissions are for IV hydration, empiric antibiotics, and observation, or if a diagnosis other than viral meningitis is being considered.

So I guess that helps answer that question, sorta. Yes, no…maybe.  But at least I feel my investigation is done and that I’m free to go to sleep now.

Speaking of sleep, the last dream I had was that Minesh was my roommate. That’s weird already, I know, but then he would sneak into my room to tie bows in my hair while I slept. So, in this dream, I’d wake up and be pulling bows out, shouting “MINESH!”  I woke up in real life, unamused.

I think I’ll stay up a little bit later after all .

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Published in: on April 16, 2010 at 6:07 am  Leave a Comment  

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