Serum sodium and osmolal changes in tuberculous meningitis

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B S Singh1, A K Patwari, M Deb

  • 1Department of Pediatrics and Microbiology, Lady Hardinge Medical College, New Delhi.

Indian Pediatrics
|November 1, 1994
PubMed

Insights

Syndrome of inappropriate antidiuretic hormone (SIADH) is common in children with tuberculous meningitis (TBM), often causing hyponatremia. Early diagnosis of SIADH is crucial for managing fluid therapy in TBM patients.

Area of Science:

  • Pediatrics
  • Neurology
  • Infectious Diseases

Background:

  • Tuberculous meningitis (TBM) is a severe infection affecting children.
  • Electrolyte imbalances, particularly hyponatremia, are common complications in TBM.
  • The syndrome of inappropriate antidiuretic hormone (SIADH) is a potential cause of hyponatremia in TBM.

Purpose of the Study:

  • To evaluate serial serum sodium levels and osmolality in children with TBM.
  • To assess the incidence and trends of hyponatremia and SIADH in TBM patients.
  • To determine the correlation between SIADH, hyponatremia, and outcomes in TBM.

Main Methods:

  • Serial measurements of serum sodium, CSF, serum, and urine osmolality in 20 TBM children and 20 controls.
  • Investigations were performed on admission, day 3, and day 10.
  • Comparison of biochemical parameters between TBM patients and controls, and assessment of SIADH presence.

Main Results:

  • TBM patients showed significantly lower serum sodium and osmolality compared to controls.
  • Hyponatremia was present in 65% of TBM cases on admission, decreasing to 30.8% by day 10.
  • SIADH was detected in all hyponatremic TBM patients on admission, with incidence decreasing over time.

Conclusions:

  • SIADH is a frequent complication in pediatric TBM, contributing to hyponatremia.
  • Early diagnosis and management of SIADH are essential for appropriate fluid therapy in TBM.
  • While SIADH is common, its direct correlation with mortality in survivors requires further investigation.

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