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

Prithi Inamdar1, Sanjeevani Masavkar2, Preeti Shanbag3

  • 1Department of Pediatrics, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.

Journal of Pediatric Neurosciences
|November 19, 2016
PubMed

Insights

Cerebral salt wasting syndrome (CSWS) is a significant cause of hyponatremia in children with tuberculous meningitis (TBM). This study found CSWS more common than SIADH in pediatric TBM patients with hyponatremia.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Endocrinology

Background:

  • Hyponatremia is a common complication in pediatric tuberculous meningitis (TBM), affecting 35-65% of children.
  • Syndrome of inappropriate antidiuretic hormone (SIADH) secretion was previously considered the primary cause of hyponatremia in TBM.
  • Cerebral salt wasting syndrome (CSWS) is increasingly recognized as a potential cause of hyponatremia in TBM.

Purpose of the Study:

  • To determine the incidence and etiological factors of hyponatremia in children diagnosed with TBM.
  • To differentiate between SIADH and CSWS as causes of hyponatremia in this pediatric population.

Main Methods:

  • Prospective study of children with newly diagnosed TBM over two years.
  • Monitoring of clinical and laboratory parameters including serum electrolytes, urine output, and urinary sodium.
  • Diagnosis of hyponatremia (<135 mEq/L), CSWS (volume depletion, natriuresis), and SIADH.

Main Results:

  • Hyponatremia occurred in 38.7% (29/75) of children with TBM.
  • Discontinuation of mannitol resolved hyponatremia in 19 patients.
  • Persistent hyponatremia was attributed to CSWS in 10 patients; no cases of SIADH were identified.

Conclusions:

  • CSWS is a significant cause of hyponatremia in children with newly diagnosed TBM.
  • CSWS was observed more frequently than SIADH in this cohort of pediatric TBM patients.
  • These findings highlight the importance of considering CSWS in the management of hyponatremia in pediatric TBM.
Abstract

Keywords:
Cerebral salt wasting syndromehyponatremiatuberculosis meningeal

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