Hyponatremia in children with tuberculous meningitis: A hospital-based cohort study

Abstract

Background:Hyponatremia has long been recognized as a potentially serious metabolic consequence of tuberculous meningitis (TBM) occurring in 35–65% of children with the disease. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has for long been believed to be responsible for the majority of cases of hyponatremia in TBM. Cerebral salt wasting syndrome (CSWS) is being increasingly reported as a cause of hyponatremia in some of these children.Aim:This study was done to determine the frequency and causes of hyponatremia in children with TBM.Methods:Children with newly diagnosed TBM admitted over a 2-year period (January 2009 to December 2010) were included. All patients received anti-tubercular therapy, mannitol for cerebral edema, and steroids. Patients were monitored for body weight, urine output, signs of dehydration, serum electrolytes, blood urea nitrogen, serum creatinine, and urinary sodium. Hyponatremia was diagnosed if the serum sodium was <135 mEq/L. CSWS was diagnosed if there was evidence of excessive urine output, volume depletion, and natriuresis in the presence of hyponatremia. The outcome in terms of survival or death was recorded.Results:Twenty-nine of 75 children (38.7%) with TBM developed hyponatremia during their hospital stay. In 19 patients, hyponatremia subsided after the discontinuation of mannitol. Ten patients with persistent hyponatremia had CSWS. There were no patients with SIADH.Conclusions:CSWS is an important cause of hyponatremia in children with newly diagnosed TBM. In our patients, it was more commonly seen than SIADH.

Tuberculous meningitis in children

“…A study among children with TBM in Mumbai showed that around 39 per cent of the children with TBM had hyponatremia and the cerebral salt-wasting syndrome was more common than syndrome of inappropriate antidiuretic hormone. Higher mortality rate was observed in children with hyponatremia than children with normal levels96. Appropriate management of this electrolyte imbalance is important in improving the treatment outcomes.…”

A Diagnostic Formula for Discrimination of Tuberculous and Bacterial Meningitis Using Clinical and Laboratory Features

“…Either cerebral salt wasting (CSW), or the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was regarded as the possible pathogenesis of hyponatraemia (Van Embden et al, 1993;Zhang et al, 1999;Reed et al, 2004;Tsenova et al, 2005;Mihailidou et al, 2012). CSW has been considered as the combination of hypovolemia, dehydration, high urinary output, weight loss, and hyponatraemia, which is due to the secretion of some natriuretic protein by the brain or arteries (Tinggaard et al, 2011;Inamdar et al, 2016;Misra et al, 2016Misra et al, , 2018Mai and Thwaites, 2017). This is sometimes due to the secretion of adrenomedullin, which is an endogenous peptide (Lang et al, 1997).…”

Hyponatremia is a potential predictor of progression in radiation-induced brain necrosis: a retrospective study

“…Moreover, the clinical symptoms of vomiting and headache, were often regarded as the results of intracranial hypertension caused by brain edema in RN patients, thus mannitol was usually applied to alleviate the symptom. Nevertheless, in fact, the symptoms could not get remission sometimes, which implied that the symptoms were not caused by brain edema, but very likely by hyponatremia [ 33 ]. The information above concludes that, on one hand, when doing irradiation therapy for the primary tumors, avoiding radiation exposure of hypothalamus and pituitarium if possible may effectively reduce the occurrence of hyponatremia from the source [ 34 , 35 ].…”