Study Of Clinical Characteristics In Tuberculous Meningitis With Hyponatremia

Objective:To explore the prevalence and clinical features of hyponatremia in tuberculous meningitis(TBM).Method:One hundred and fifteen patients were enrolled,which are diagnosed with TBM in the hospital from Jan 2014 to Oct 2016.General information and clinical data were collected.Clinical features of TBM with and without hyponatremia were compared.Occurence of hyponatremia in TBM was calculated.Compared clinical features of patients with and without hyponatremia.Result:In our study,70.4% patients were with hyponatremia.Compared with normonatremic counterparts,besides lower serum sodium and plasma osmotic pressure,patients with hyponatremia also tended to have lower serum creatinine[54.5(45.2,68.0)vs.64.0(54.5,75.7)μmmol/L,P=0.004],blood uric acid[164.0(123.5,218.2)vs.229.5(178.5,327.0)μmmol/L,P<0.001],glucose[2.0(1.7,3.0)vs.3.0(2.0,4.0)mmol/L,P=0.002] and chloride content in cerebrospinal fluid.Both temperature[2.0(1.7,3.0)vs.3.0(2.0,4.0)mmol/L,P=0.002] and protein content[112.0(104.0,116.0)vs.120.0(116.2,125.7)mmol/L,P<0.001] in cerebrospinal fluid were higher in the hyponatremic patients.There is no significantdifference of gender or age between this two groups.According to the analysis of the reason for TBM with hyponatremia,65.4% patients with SIADH.Compared with the patients with hyponatremia for other reason,patients with SIADH had lower serum sodium,plasma osmotic pressure,blood uric acid,chloride content in cerebrospinal fluid.Cerebrospinal fluid pressure was higher.In patients with SIADH,as high as90.6% of them were missed diagnosis.Conclusion: According to this study,the incidence of TBM with hyponatremia is high.SIADH is an important cause of TBM with hyponatremia.