Cerebral Salt-Wasting Syndrome in a Patient With Active Pulmonary Tuberculosis

Abstract

A 37-year-old female with a medical history of recently diagnosed active pulmonary tuberculosis and a new intracranial lesion presented with altered mental status, nausea, and vomiting for two days. An initial physical examination revealed that the patient was euvolemic. Laboratory findings revealed a serum sodium concentration of 105 mEq/L. During her admission, she was initially managed with lactated ringer solution in the emergency department, followed by 3% normal saline in the intensive care unit, and, eventually, on oral sodium chloride and fluid restriction on discharge. Once she was stabilized, she had episodes of dizziness, and concerns were raised about the salt-wasting syndrome.

Hyponatremia in Tuberculosis Meningitis: Navigating the Diagnostic Challenges of Cerebral Salt Wasting – A Case Report

“…[2][3][4][5][6] CSW can contribute to hyponatremia in patients affected by neurological conditions. 7 CSW and SIADH share comparable features and laboratory indicators, yet distinct treatment approaches, emphasizing the significance of accurate diagnosis and effective management. Diagnosis of CSW involves identifying evidence of hypovolemia, hyponatremia with reduced plasma osmolality, inappropriately increased urine osmolality, elevated urine sodium concentration indicating a negative sodium balance, and low serum uric acid concentration due to urate excretion in urine.…”

“…Diagnosis of CSW involves identifying evidence of hypovolemia, hyponatremia with reduced plasma osmolality, inappropriately increased urine osmolality, elevated urine sodium concentration indicating a negative sodium balance, and low serum uric acid concentration due to urate excretion in urine. 7 Distinguishing between CSW and SIADH is crucial, as treatment for one condition could worsen the other. 3 Here, we present a case of a pediatric and laboratory, the child was diagnosed with tuberculous meningitis and cerebral salt wasting.…”