Hyponatremia Incidence and its Association with Mortality in Patients with Pulmonary Tuberculosis Observational Study

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Jeremy Javier Hernandez Rios, MD
Jesus Alan Guardado Vindiola, MD
Joaquín Cordova Erberk
Katya Lorena Wilhelmy Ledesma
Paola Alejandra Sterling Carrillo
Marina Estrada Rodríguez
Hiram Javier Jaramillo Ramirez, MD

Abstract

Introduction: Pulmonary tuberculosis has been of great interest for us given the high number of cases in our community at the Mexican-American border, however, this abundance of patients allows us to observe whether there is an association between the previously described development of hyponatremia and mortality in these patients.


Objective: To determine the association between mortality and hyponatremia in patients with pulmonary tuberculosis.


Material and Methods: We analyzed the electronic health record of patients with a pulmonary tuberculosis diagnosis from a 4-year period in the General Hospital of Mexicali, in  México. Inclusion criteria were patients over the age of 18, a pulmonary tuberculosis diagnosis, and complete laboratory tests. The collected data was then analyzed through descriptive statistics.


Results: 116 patients with pulmonary tuberculosis were included, of which 91 (78.4%) were male. A history of past Infection with the Human immunodeficiency virus and previous tuberculosis infection were shown to correlate with higher mortality and requirement of intensive care. The logistic regression analysis showed that hyponatremia had no association with mortality or the need for intensive care. Complications such as Acute respiratory distress syndrome and Acute kidney injury were related to higher mortality and need for critical care.


Conclusions: The incidence of hyponatremia was higher than previously described, but there was no statistical association between hyponatremia and mortality in comparison to patients with normal sodium. Among this study’s weaknesses, most patients were hospitalized at the time of diagnosis, implying they could already have had a complication, thus increasing the incidence.

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How to Cite
Jeremy Javier Hernandez Rios, MD, Jesus Alan Guardado Vindiola, MD, Joaquín Cordova Erberk, Katya Lorena Wilhelmy Ledesma, Paola Alejandra Sterling Carrillo, Marina Estrada Rodríguez, & Hiram Javier Jaramillo Ramirez, MD. (2022). Hyponatremia Incidence and its Association with Mortality in Patients with Pulmonary Tuberculosis Observational Study. International Journal of Medical Science and Clinical Research Studies, 2(3), 218–226. https://doi.org/10.47191/ijmscrs/v2-i3-05
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References

I. Tuberculosis [Internet]. World Health Organization. 2021 [citado 30 agosto 2021]. Available en: https://www.who.int/es/news-room/fact-sheets/detail/tuberculosis

II. Orozco I., Acosta J, Rodriguez G. Martinez F. Enriquez A, Espinoza M, Duran O. & Orozco I. Epidemiología de tuberculosis pulmonar en población migrante. Neumol Cr Torax. 2018.

III. Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison´s principles of internal medicine. Vol 1 18th ed. New York: Mc Graw Hill; 2013; 648-661.

IV. Westwater JO, Stteven D, Garry RC. A note on the serum sodium level in patients suffering from tuberculosis. Clin Sci 4:73-77, 1939

V. SIMS EA, WELT LG, ORLOFF J, NEEDHAM JW. Asymptomatic hyponatremia in pulmonary tuberculosis. J Clin Invest. 1950 Jun;29(6):846-7. PMID: 15436829.

VI. Weiss H, Katz S. Hyponatremia resulting from apparently inappropriate secretion of antidiuretic hormone in patients with pulmonary tuberculosis. Amer Rev Resp Dis 92:609-616, 1965. doi: 10.1164/arrd.1965.92.4.609.

VII. SHALHOUB, R. J. The Mechanism of Hyponatremia in Pulmonary Tuberculosis. Annals of Internal Medicine, 70(5), 943. doi:10.7326/0003-4819-70-5-9

VIII. Chung D. Hyponatremia in untreated active pulmonary tuberculosis. American Review of Respiratory Disease. Vol 99: 595-596. 1969. doi: 10.1164/arrd.1969.99.4P1.595.

IX. DeFronzo RA, Goldberg M, Agus ZS. Normal diluting capacity in hyponatremic patients. Reset osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion. Ann Intern Med. 1976 May;84(5):538-42. doi: 10.7326/0003-4819-84-5-538.

X. Hill R, Uribarri J, Mann J, Berl T. Altered water metabolism in tuberculosis. Role of Vasopressin. The American Journal of Medicine. Vol 88: 357-364. 1990. doi: 10.1016/0002-9343(90)90489-z.

XI. Vorherr H. Massry SG, Fallet R, Kaplan L. Kleeman CR. Antidruretic principle in tuberculous lung tissue of a patient with pulmonary tuberculosis and hyponatremia. Ann Intern Med. 72: 383-387. 1970. doi: 10.7326/0003-4819-72-3-383

XII. Baran D,HutchinsonTA: The outcome of hyponatremia in general hospital population.clin nephrol. 22:72-76. 1984

XIII. Bennani SL,Abouqal R,Zeggwagh AA,Madani N,Abidi K et al. incidence,causes & prognostic factors of hyponatremia in intensive care. rev med interne 24(4):224-9. 2003. doi: 10.1016/s0248-8663(02)00811-1.

XIV. Sharma SK, Mohan A, Banga A, Saha PK, Guntupalli KK. Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis. Int J Tuberc Lung Dis.10(4):429-35. 2006. doi: 10.1186/1471-2334-12-121

XV. Babaliche P, Madnani S, Kamat S. Clinical profile of patients admitted with hiponatremia in the medical intensive care unit. Indian J Crit Med. 21:819-24.2017

XVI. Jafari N, Izadi M, Sarrafzadeh F, Heidari A, Ranjbar R, Saburi A. Hyponatremia due to pulmonary tuberculosis: Review of 200 cases. Nephro Urol Mon. 5(1): 687-91. 2013

XVII. Underwood J, Cresswell F, Salarm A, Keely A, Clelad C & John L. Complications of miliary tuberculosis: low mortality and predictive biomarkers from UK cohort. Infectious Diseases.17:295-302. 2017

XVIII. Llamas-Lopez A, Vargas T & Maya R. Hyponatremia incidence and its Association With Mortality in Patients With Tuberculosis. Poster Abstracts OFID. Vol. 5: pg283. 2018. doi: 10.1093/ofid/ofy210.798

XIX. Singla A, Raghu B, Gupta A, Caminero J, Sethi P, Tayal O, Chakraborty A & Migliori G. Risk factors for early mortality in patients with pulmonary tuberculosis admitted to the emergency room. Pulmonol. No 8: Pg 1444-1452 2020. doi: 10.1016/j.pulmoe.2020.02.002. Epub 2020 Feb 29.

XX. Hashimoto M et all. Mild Lung Tuberculosis in a Patient Sufferin from Status Epilepticus Caused by the Syndrome of Inappropriate Secretion of Antidiuretic Hormone ( SIADH). Intern Med 56: 429-433, 2017.

XXI. Martínez-Hernández YO, Guzmán-López F, Flores-Pulido JJ, Vázquez-Martínez VH. Factores familiares que favorecen el apego al tratamiento en casos de tuberculosis pulmonar. Aten Fam. 21(2):47-49.2014

XXII. Luies L, du Preez I. The Echo of Pulmonary Tuberculosis: Mechanisms of Clinical Symptoms and Other Disease-Induced Systemic Complications. Clin Microbiol Rev. 2020 Jul 1;33(4):e00036-20. doi: 10.1128/CMR.00036-20. PMID: 32611585; PMCID: PMC7331478.

XXIII. Olalekan A., Oluwaseun F., Oladele H. & Akeem A. (2015) Evaluation of electrolyte imbalance among tuberculosis patients receiving treatments in Southwestern Nigeria, Alexandria Journal of Medicine, 51:3, 255-260, DOI: 10.1016/j.ajme.2014.10.003

XXIV. Cerda-Esteve, Mariana, Agustín Ruiz-González, Mindaugas Gudelis, Albert Goday, Javier Trujillano, Elisa Cuadrado, y Juan Francisco Cano. «Incidencia de la hiponatremia y de sus causas en pacientes neurológicos». Endocrinología y Nutrición 57, n.o 5 (2010): 182-86.https://doi.org/10.1016/j.endonu.2010.02.009.

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