Etiological Spectrum and Outcome of Hyponatremia in Tubercular Meningitis Patients: A Hospital-based, Prospective, Observational Study
Sruthi Ramindla, Mujahid Beg, Ruhi Khan, Saifullah Khalid, Saif QuaiserAbstract
Background:
Hyponatremia in tuberculous meningitis (TBM) is a commonly observed dyselectrolytemia with morbid outcomes if not addressed promptly. Hyponatremia independently contributes to poorer outcomes in hospitalized patients. Several authors reported the occurrence of hyponatremia among TBM patients in a frequency ranging from 35% to 71%. Due to meagre research on the condition, its frequency, the effect of its severity, and outcome, this study was conducted to determine the effect of the severity of hyponatremia in TBM.
Aim:
To determine the effect of the severity of hyponatremia and inhospital outcome in patients with TBM.
Materials and Methods:
It is a hospital-based, descriptive, observational, cross-sectional study conducted on 55 patients of >14 years of age diagnosed with TBM with hyponatremia. Hyponatremia was classified as severe, moderate, and mild, respectively. The severity of TBM was categorized using the Medical Research Council (MRC) grading. Disability was assessed with the help of the modified Rankin score (mRS). Death in the hospital and its possible causes were noted.
Duration of Study:
This study had been conducted over a period of 2 years, from August 2022 to July 2024.
Results:
Of the 55 patients, 34 individuals (61.8%) had definitive TBM, 17 patients (30.9%) had probable TBM, and four patients (7.3%) had possible TBM. Cerebral salt wasting (CSW) was the most common cause of hyponatremia observed in 25 patients (45.5%), followed by syndrome of inappropriate antidiuretic hormone secretion (SIADH) seen in 15 patients (27.3%). Mild hyponatremia was identified in 16 individuals or 29.1% of the total. Moderate hyponatremia was detected in 23 individuals, accounting for 41.8% of the total. Severe hyponatremia was found in 16 individuals, or 29.1% of the total. Forty-one patients presented in MRC Grade III severity, representing 74.5% of all cases. Mortality in our study was 29%. The mean serum sodium of expired patients was 116.25 ± 5.6 mmol/L. The severity of hyponatremia is strongly associated with mortality and poorer outcomes. Higher mRS scores at discharge correlate with the severity of TBM.
Conclusion:
Hyponatremia can be considered a poor prognostic factor for mortality in TBM. The severity of hyponatremia is related to poorer outcomes.