A Nosey One

[Veneficus]

no need to call yourself names to ask a question

Could you expound on your "decrease in glucose" thoughts a bit? I'm just a nitwit EMT-B. How does a lumbar puncture lead to low glucose?

One of the most important, if not the most important aspect of menigitis is to distinguish bacterial/fungal which left untreated is often fatal; from Viral, when left untreated often is not.

You are basically looking at the findings of the CSF.

In Bacterial fungal infection, in CSF (as opposed to blood) you expect to see:

a cell count of 1000-20,000/mm3 (white cells)
>90% neutrophils
a decreased level of CSF glucose (from bacterial metabolism) Normally it should be between 45-80 mg/dl <40 is often diagnostic.
an increase in CSF protein
Usally it is a Gram + bacteria and the culture is most often positive (greater than 65% of cases)

Viral:
<1000 cells/mm3 (white cells)
neutrophils for ~48 hours switching to lymphocyte/monocytes (normal for viruses everywhere)
CSF glucose WNL unless mumps or herpes is also present.
negative gram stain (there is no bacterial cell wall to be stained)

 

[CAOX3]

Polar bear attack, you got them in New Zealand right?

 

[Melclin]

Polar bear attack, you got them in New Zealand right?

Nah mate. Drop bears. Although ours are bigger.

 

[CAOX3]

a decreased level of CSF glucose (from bacterial metabolism) Normally it should be between 45-80 mg/dl <40 is often diagnostic.

Just curious any idea how long after onset of symptoms will these findings be present?

And soon I will have my cisternal puncture certification, its a four hour add on class this Saturday.

 

[Veneficus]

Just curious any idea how long after onset of symptoms will these findings be present?

The lab findings should be present before symptoms. The CSF is very difficult for bacteria to penetrate into (it is the last place they are found) in order to create symptoms the microbes wold already have to be outstripping the immune response.

And soon I will have my cisternal puncture certification, its a four hour add on class this Saturday.

Four hours!!! if you just take the skill part instead of all that physiology stuff that doesn't make a difference in the field you can get it in 1.

 

[Cawolf86]

If no more brain storming on the scenario occurs - is it possible to post the results?

Thanks.

 

[MrBrown]

It was meningitis