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      Hyponatremia Due to Pulmonary Tuberculosis: Review of 200 Cases

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          Abstract

          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.

          Patients and Methods

          We evaluated patients with diagnosis of secondary PTB who have been admitted to Baqiyatallah hospital, Tehran, Iran from 2005 till 2010. The diagnosis of PTB was based on the appearance of acid fast bacilli in sputum smears or sputum cultures, without any evidence of miliary TB. Demographic and laboratory characteristics relative to electrolytes were recorded according inclusion and exclusion criteria.

          Results

          The mean age was 59.22 ± 20.57 years and 91 (45.5%) patients were male. The mean serum sodium concentration was 134.54 ± 4.95 mmol/L and more than half of subjects (51%) have shown hyponatremia. The mean age difference between hyponatremic and eunatremic groups was statistically significant (61.95 versus 56.02 years) (P = 0.047). No significant relationship was found between hyponatremia and gender, anti-TB medications and co-morbidity conditions.

          Conclusions

          In this study, an older age was suggested as an important predisposing factor for hyponatremia in patients with PTB which had been observed as less of a determinant. We recommend further evaluations for hyponatremia in patients presenting with PTB, particularly for those who are older.

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          Most cited references31

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          Incidence and prevalence of hyponatremia.

          Hyponatremia is the most common electrolyte abnormality encountered in clinical practice. The reported frequency of the disorder is determined by a number of factors, including the definition of hyponatremia, the frequency of testing, the healthcare setting, and the patient population. This review focuses on the incidence and prevalence of hyponatremia. In acute hospital care, particular attention is given to admission versus hospital-acquired hyponatremia. Although less well studied, the epidemiology of hyponatremia in the ambulatory-based setting and the geriatric/nursing home population is also summarized. Finally, the frequency of hyponatremia occurring in special clinical conditions--including congestive heart failure, cirrhosis, pneumonia, and acquired immunodeficiency syndrome--as well as in marathon runners will be reviewed. Substantial additional work is still required to determine the true occurrence of hyponatremia in the various clinical settings. Beyond the phenomenologic value, advances in the epidemiology of hyponatremia should also provide insights in the prognostic implications as well as the preventive and management strategies of the disorder in various clinical settings.
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            Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis.

            To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB). Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB. Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P 100 IU (OR 15.7, 95%CI 3.0-81.1, P 18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die. In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.
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              Predictors of outcome in hospitalized patients with severe hyponatremia.

              Severe hyponatremia is associated with increased morbidity and mortality. Clinicians treating patients with severe hyponatremia are often torn between a desire to promptly raise serum sodium concentration to a "safe range," and at the same time, to avoid excessively rapid correction of hyponatremia. The aim of this study was to assess the prevalence of severe hyponatremia in hospitalized patients, the etiologic factors involved, as well as treatment and outcome of the patients using a retrospective case series. Retrospective study of 168 patients with severe hyponatremia (< 115mmol/L) seen at Grady Memorial Hospital, a tertiary teaching hospital, in Atlanta, Georgia, from 1997-2001. The main outcome measures of interest were death during admission or occurrence of neurologic symptoms before, during or after therapy. One hundred sixty-eight patients met the inclusion criteria out of a total of 5994 patients with hyponatremia treated at our hospital over the study period. Eighty-nine patients (52.9%) were symptomatic. The mean absolute serum sodium at 48-hours of therapy was 120.02 +/- 8.31 mmol/L. Respiratory failure and/or hypoxia was present in 28 patients (16.7%); sepsis was documented in 16 patients (9.5%). Mortality rate was high, 34 patients died (20.2%). On multivariate analysis factors with strong association with mortality of patients with severe hyponatremia were hypoxia, presence of neurologic symptoms, slow correction rates and a diagnosis of sepsis. The mortality associated with severe hyponatremia remains high. Sepsis, respiratory failure and the presence of symptoms predict poor outcome in hospitalized patients with severe hyponatremia. More aggressive therapy with 3% saline may improve outcome in symptomatic patients. Our data suggest that a slow rate of correction in severe hyponatremia is associated with higher mortality than rapid correction, at least in the short-term.
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                Author and article information

                Journal
                Nephrourol Mon
                Nephrourol Mon
                10.5812/numonthly
                Kowsar
                Nephro-urology monthly
                Kowsar
                2251-7006
                2251-7014
                15 December 2012
                Winter 2013
                : 5
                : 1
                : 687-691
                Affiliations
                [1 ]Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                [2 ]Department of Internal Medicine, Infectious Ward, Afzalipour Educational Medical Center, Kerman University of Medical Sciences, Kerman, IR Iran
                [3 ]Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                [4 ]Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                [5 ]Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                Author notes
                [* ]Corresponding author: Amin Saburi, Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra St, Vanak Sq, Tehran, IR Iran. Tel.: +98-9127376851, Fax: +98-2188600067, E-mail: aminsaburi@ 123456yahoo.com .
                Article
                10.5812/numonthly.7091
                3614323
                23577332
                571c2362-056d-439b-908f-3a734baa326a
                Copyright © 2013, Kowsar Corp.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 July 2012
                : 28 August 2012
                : 10 September 2012
                Categories
                Research Article

                tuberculosis,hyponatremia,causality
                tuberculosis, hyponatremia, causality

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