The Incidence and Risk Factors of Hyponatremia in Pulmonary Tuberculosis

Abstract

Background The syndrome of inappropriate antidiuresis (SIAD) with euvolemic hyponatremia may occur in patients with pulmonary tuberculosis (PTB), but little is known about the clinical characteristics of SIAD-associated hyponatremia in PTB patients. Purpose This study aimed to investigate the frequency and risk factors of hyponatremia in PTB patients. Methods In this retrospective chart review, we examined the incidence and severity of hyponatremia in PTB patients. Multivariate analysis was conducted to identify risk factors for hyponatremia in PTB patients. Results Of the 161 patients who were screened, after excluding patients with hyperglycemia and renal failure, we enrolled and analyzed data from 113 participants. Hyponatremia occurred in 40.7% patients (<135 mEq/L). Univariate analysis revealed that the presence of hyponatremia was associated with old age, female sex, low body mass index, and high glycosylated hemoglobin, C-reactive protein (CRP), and NT-proBNP values. Multivariable analysis indicated that hyponatremia was strongly associated with old age (odds ratio, 1.06; 95% confidence interval, 1.03–1.09 for every 1-year age increase) and CRP values (odds ratio, 1.15; 95% confidence interval, 1.03–1.30 for every 1-mg/dL increase in CRP). For 86 patients with blood cortisol measurements, the cortisol level was significantly high in the hyponatremia group. Conclusions Hyponatremia was less frequently associated with hyperglycemia, heart failure, renal failure, and other diseases that cause euvolemic hyponatremia; thus, PTB patients may have euvolemic hyponatremia due to SIAD. Administration of hypertonic saline or fluid restriction should be considered in PTB patients with hyponatremia.

Pulmonary tuberculosis in an adult presenting with severe hyponatremia: A case report and review of literature

“…Additionally, tuberculous involvement of the central nervous system can disrupt the normal regulation of ADH release, further contributing to hyponatremia 12–14 . Patients with PTB who are older and have an increased CRP level are likely to have hyponatremia 15 …”

“… 12 , 13 , 14 Patients with PTB who are older and have an increased CRP level are likely to have hyponatremia. 15 …”

Hyponatremia in Young Patients with Pulmonary Tuberculosis and Tuberculous Meningoencephalitis

“…Hyponatremia can arise from two factors: Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and Cerebral Salt Wasting (CSW) (Yoshida et al, 2022). SIADH occurs when the normal secretion of AVP (antidiuretic hormone) is disrupted due to hypothalamic or pituitary gland injury or dysfunction (Wilke, 2021), while CSW is characterized by hypovolemia and negative salt balance (Liangos & Madias, 2021).…”

Pulmonary Tuberculosis in an Adult Presenting With Severe Hyponatremia: A Case Report and Review of Literature

“…Additionally, tuberculous involvement of the central nervous system can disrupt the normal regulation of ADH release, further contributing to hyponatremia [13][14][15]. Patients with PTB who are older and have an increased CRP level are likely to have hyponatremia [16].…”