Prevalence of hyponatremia in pulmonary

tuberculosis A pilot study from a tertiary care

center in south India

Bhanu Rekha Bokam, Vijayalakshmi Udipi Badikillaya

International Journal of Medical Science and Public Health 2017;6:75-79

dr. Radit Nouval

Divisi Ginjal Hipertensi
 INTRODUCTION
Pulmonary tuberculosis (PTB) is one of the common diseases
with high prevalence of mortality and morbidity in developing
countries.

Globally, PTB prevalence in 2015 was 42%. India (23%),

Indonesia (10%) and China(10%) had the largest number of
cases.

Hyponatremia is considered as one of the most common

electrolyte abnormalities which must be considered in all
seriously ill hospitalized patients
Mild Hyponatremia

Serum Sodium Concentration between 130 - 134 mmol/L

Moderate Hyponatremia

Serum Sodium Concentration between 125 129 mmol/L

Severe Hyponatremia

Serum Sodium Concentration < 125 mmol/L

TB induce local invasion to the adrenal glands
hyponatremia (adrenal insufficiency)
via several
mechanisms
local invasion to hypothalamus or
pituitary

inappropriate ADH secretion via

pulmonary infection

Aims and Objectives : To study the serum sodium

levels and to see the prevalence of hyponatremia in
patients with PTB.
 MATERIALS AND METHODS
- cross-sectional observational
study
- Studied period 2014 to 2016
- 410 patients
Diagnosis of PTB was made on :
- the basis of clinical
presentation
- chest radiograph findings
- microscopic detection of acid-
fast bacilli (AFB)
Patients presented to : the
department of Pulmonary
medicine Dr PSIMS & RF,
India.
Data Studied :
- Serum sodium concentration
- Chest radiographs was
focused on extent of lung
parenchymal lesion
- The grade of sputum smear
Inclusion criteria Exclusion criteria

- Patients aged 18 years and - Patients with old TB

above - renal failure patients
- diagnosed as having active - endocrine abnormalities
PTB - patients receiving diuretics
and medications related to
SIADH.
 RESULTS

Prevalence of hyponatremia
 DISCUSSION
The age ranged of subjects from 18 to 80
years.
The most - ours being a tertiary care hospital
common age
was 4060
years , by the
reason - patients come after delayed
diagnosis

- stopping the treatment course

- after being treated by other doctors
Out of 410 Crook et al observed that of those
subjects with PTB with hyponatremia 61% had chest
254 (61.9%) infection.
patients had
hyponatremia.

Biswas et al observed syndrome of

inappropriate anti diuretic
hormone secretion (SIADH) is the
most commonly encountered form
of hyponatremia.
The mean
serum sodium Soiza et al have observed that
levels in the chronic mild hyponatremia is
subjects above common in old and frail
60 years was individuals
slightly lower
Around 204 Of those with severe hyponatremia
patients out (serum sodium value less than 125
of the 332 mmol/L), 92.3% were sputum positive.
who were
sputum Among those with severe
positive had
hyponatremia 76.9% had involvement
hyponatremia
of both lung fields
(61.4%).
The present findings indicate that the
severity of TB and hyponatremia were
directly proportional
Most of the Symptoms occurred only acute
patients in the exacerbation in patients with
present study had chronic hyponatremia or when
asymptomatic serum sodium fell below 110
hyponatremia meq/l.

Waikar et al have also found

increased incidence of mortality
in hyponatremia patients,
irrespective of the degree of
Hyponatremia.
 CONCLUSION
Hyponatremia was observed to the
extent of 61% in patients with PTB

Severity of hyponatremia was directly

proportional to sputum positivity and
extensive involvement of pulmonary
parenchymal lesions

There was no gender difference with

relation to hyponatremia
Terima Kasih