Prevalence of hyponatremia in pulmonary tuberculosis

Journal of Tuberculosis Research

Introduction: Tuberculosis (TB) is one of the major public health problems in Pakistan. Our country ranks fifth in tuberculosis high-burden countries worldwide. Hyponatremia is considered as one of the most common and important electrolyte abnormality in Pulmonary TB (PTB) patients. This study will show the prevalence of hyponatremia in PTB in our population. Objective: To evaluate the prevalence of hyponatremia in pulmonary tuberculosis patients. Study Design: Cross-sectional, descriptive study at Jinnah postgraduate medical centre Karachi from August 2017 to August 2018. Material and Methods: In this cross-sectional study, all patients with TB admitted in chest ward were enrolled. Patients having tuberculous meningitis, syndrome of inappropriate Ant diuretic hormone (SIADH), Renal failure, pneumonia, Cirrhosis taking medicines (diuretics, ACEI, and ARBs) were excluded. A pre-designed questionnaire was used to assess hyponatremia and its potential causes other than TB. Chi-square or Fischer exact test was used to identify factors associated with hyponatremia. Results: Ninety-six patients with mean age were 40.14 ± 13.02 years (ranging 18-65 years). Predominantly, patients were females 50 (52.08%). Overall Serum Na, Mean ± SD was 130.53 ± 6.99 (Ranging 110-146). Sixty one patients (63.5%) were younger than 40 years. Forty patients (41.66%) were smokers: 16 (16.7%) had diabetes mellitus (DM), and 15 (15.6%) had hypertension. Sixty-nine (71.87%) patients had hyponatremia of which 45 (73.77%) were less than 40 years (p = 0.375). Diabetes mellitus, female gender, smoking, hypertension and duration of disease were not associated with increased risk of hyponatremia having P Values: p = 0.082, p = 0.39, p = 0.57, p = 0.20 and p = 0.45 respectively.

IP innovative publication pvt. ltd, 2019

Introduction: Pulmonary Tuberculosis (PTB) is one of the paramount causes of morbidity and mortality in the developing and underdeveloped countries. India is the country with the highest burden of PTB. Among the electrolyte imbalance hyponatremia is observed commonly which will lead to increase in morbidity and mortality. In this study, the prevalence of hyponatremia in adult pulmonary tuberculosis patients was done. Methodology: In this retrospective study; patients of age more than 18 years presented to our department from 2016 to 2017 were included. PTB was diagnosed as per the institutional protocol, i.e., on clinical presentation of the patient, microscopic examination suggestive of acid-fast bacilli (AFB) and an abnormal chest radiograph findings. All the case files of patients having PTB in the study period were collected and demographic parameters and relevant laboratory findings were noted and analyzed. Results: A total of 150 patients with PTB were included in this study between 18 to 86 years of age group. Mean age of patients was 50.92 + 17.76. Among 150 patients, 114 (76%) had hyponatremia with serum sodium levels less than 135mmol/l out of which 84 (74%) were males and 30 (26%) were females. Out of 150 patients 59 (39%) had mild hyponatremia; 41 (27%) had moderate hyponatremia and 14 (9%) had severe hyponatremia. In all the groups of hyponatremia, majority were found to be males. 27 (46%) in mild hyponatremia, 34 (83%) in moderate hyponatremia and 11(79%) in severe hyponatremia were sputum AFB positive. Many patients were asymptomatic except 4 with severe hyponatremia requiring vasopressor support for hypotension. Conclusions: Patients with PTB should be evaluated for hyponatremia; early detection and treatment of can potentially reduce morbidity and mortality. Keywords: AFB; Hyponatremia; Mortality; Pulmonary tuberculosis.

2012

Background: Pulmonary Tuberculosis (PTB) is one of the common diseases with high prevalence of mortality and morbidity in developing countries. Various complications have been reported along with PTB. The subclinical electrolyte imbalances are customary in cases with PTB. Objectives: The aim of this study was the evaluation of patients with PTB and hyponatremia.

Journal of Child Science

Introduction Pulmonary tuberculosis (PTB) is one of the rare pulmonary infections causing hyponatremia (serum sodium ˂135 mmol/L) and severe hyponatremia (serum sodium ˂125 mmol/L). Although the major cause of hyponatremia in TB patients is syndrome of inappropriate antidiuretic hormone (SIADH) secretion, cerebral salt wasting syndrome (CSWS) can occur and requires evidence of inappropriate urinary salt losses and reduced arterial blood volume. Adrenal insufficiency (AI) is rare in TB with scanty literature describing it. The two reported cases highlight three possible causes of severe symptomatic hyponatremia in TB pleural effusion and disseminated TB, their treatment modalities, and the need to increase the index of suspicion to diagnose TB hyponatremia in children. Case Report Case 1: a 10-year-old girl with TB pleural effusion who developed recurrent hyponatremia in the first few weeks of anti-TB treatment which was responsive to sodium correction. Case 2: an 8-year-old girl pre...

Background: Hyponatremia is a frequently encountered electrolyte disturbance in patients with Pulmonary Tuberculosis (PTB). The pathophysiological mechanism identified for hyponatremia in Pulmonary Tuberculosis include Adrenal Insufficiency and Syndrome of Inappropriate ADH secretion (SIADH). The symptoms of adrenal insufficiency are often merged with the symptoms of tuberculosis and hence adrenal insufficiency is often overlooked in these patients. Identifying adrenal insufficiency in patients of tuberculosis is a priority as these patients may progress to adrenal crisis which can be life threatening. Objective: To evaluate the prevalence of adrenal insufficiency in hyponatremic patients with pulmonary tuberculosis Materials and Methods: The study was conducted in the department of Medicine and Pulmonary Medicine, Christian Medical College and Hospital, Ludhiana over a period of one year. All patients diagnosed with pulmonary tuberculosis (PTB) meeting the inclusion criteria were included in the study. An ACTH stimulation test using synthetic ACTH (Acton Prolongatum) was performed on all the patients. A diagnosis of adrenal insufficiency was made when post ACTH cortisol was less than 18 ng/dl. The hyponatremic patients were identified and the prevalence of adrenal insufficiency in them was seen. Results: A total of 84 patients diagnosed with pulmonary tuberculosis formed the study group. There were 45 (53.57%) females. The mean age of the study population was 49.4± 18.84 years. The mean sodium of the study group was 133.18 ± 6.48mEq/L. Majority of the patients, i.e 52 (61.90%) had hyponatremia and profound hyponatremia with serum sodium less than 125 mEq/L was present in 7 (8.33%) of the patients. Adrenal insufficiency was present in 7 (8.33%) of the patients of pulmonary tuberculosis. Amongst the 52 patients with hyponatremia, adrenal insufficiency was present in 5 (9.61%) of them. Conclusion: Hyponatremia was present in majority of the patients of pulmonary tuberculosis. Amongst the patients of hyponatremia, adrenal insufficiency was present in 9.61% of them.

Identifying pulmonary pathology while evaluating electrolyte disorders is crucial for optimal patient management. Physicians working in endemic regions of tuberculosis should consider this pathology as a differential for electrolyte imbalances.

Journal Of Evidence Based Medicine And Healthcare, 2021

Background Tuberculosis (TB) remains a major public health problem in India. TB worsens glycaemic control in patients with diabetes mellitus (DM), complicating the treatment for each condition leading to poor treatment outcomes and increase in morbidity / mortality. Human immunodeficiency virus - tuberculosis (HIV-TB) co-infections are on the rise. The objectives of the study were to describe various comorbidities in patients with tuberculosis, determine expected radiological presentations in these patients and to determine prognosis altering metabolic indicators in patients with TB. Methods A prospective cross-sectional study using data of 40 microbiologically diagnosed TB patients admitted in wards of C.G. Hospital, JJM Medical College, Davangere, from January to March 2020 was done. Chest x-rays, clinical and haematological tests were analysed. Results TB patients with DM, kidney disease, HIV presented with higher count of fibrosis, cavities and infiltrates on chest radiographs, and was worse with renal function. Hospitalisation was prolonged in patients with anaemia, multidrug-resistance tuberculosis (MDR-TB), urosepsis, and HIV as compared to patients with no comorbidities. MDR-TB showed more fibrosis. Patients with urosepsis had higher incidence of multiple lesions and effusion by 4 times. Conclusions Increased HbA1c and sugar levels lead to increase in lesions on chest x-ray in tuberculosis. Good glycaemic control in TB is a must to achieve good control of DM and reduce hospitalisation. Keywords Tuberculosis, Diabetes Mellitus, HbA1c, Chest X-Ray

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

In the present study bacteriologically confirmed and/or clinico-radiologically diagnosed new or recurrent cases of pulmonary and extrapulmonary tuberculosis attending the OPD and IPD of Dept of Respiratory Medicine of I.P.G.M.E &R /S.S.K.M hospital Kolkata from December 2017 to May 2019 were studied for socioeconomic status using Modified B.G.Prasad scale 2017 and Nutritional status using their Body Mass Index. The various haematological and biochemical parameters were determined and correlation of these parameters with body mass index and Socioeconomic class were evaluated. 79.25 % patients of Pulmonary tuberculosis and 27.08% patients of Extrapulmonary Tuberculosis had anaemia, showing increasing prevalence of anaemia in pulmonary than extrapulmonary tuberculosis. In both pulmonary and extrapulmonary tuberculosis having anaemia, normocytic normochromic type is more common than microcytic hypochromic type. 49.05% cases of pulmonary tuberculosis and 41.67 % cases of extrapulnary tub...

Biomedical Research, 2011

Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB), but their micronutrient status, especially of Vitamin A and Zinc, is still poorly documented. The objective of this study was to investigate the micronutrient status of patients with active pulmonary tuberculosis, admitted in the Department of Pulmonary Medicine, CSM Medical University UP, Lucknow. In this case-control study, 43 patients aged 18-55 year with active pulmonary TB were enrolled and blood sample was taken. Cases had clinical and radiographic abnormalities consistent with pulmonary TB and at least two sputum specimens showing acid-fast bacilli. Micronutrient status data were collected. Compared with healthy control cases, TB patients had significantly lower concentrations of blood haemoglobin, WBC count, serum albumin, serum retinol and zinc, whereas the concentration of free erythrocyte zinc protoporphyrin concentration, was greater. In conclusion, the micronutrient status of patients with active pulmonary TB was poor compared with healthy subjects. Low concentrations of haemoglobin and of serum retinol and zinc were more pronounced in malnourished TB patients.

The International Journal of Tuberculosis and Lung Disease, 2017

SETTING: Pune, India.OBJECTIVES: To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB).DESIGN: Screening for DM was conducted among adults (age  18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c]  5.7–6.5% or fasting glucose 100–125 mg/dl) and DM (HbA1c  6.5% or fasting glucose  126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease.RESULTS: Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33–10.48) and each per cent increase in HbA1c (aOR...