Sodium Imbalance in Children with Tuberculous Meningitis: A Cohort Study

Arifianto; Tuty Rahayu; Syairah Banu; Fatimatuzzuhroh; Alya Darin Wijaya

doi:10.33476/ms.v12i2.5831

Authors

Arifianto 1Department of Child Health, Pasar Rebo District General Hospital, Jakarta
Tuty Rahayu 1Department of Child Health, Pasar Rebo District General Hospital, Jakarta
Syairah Banu Department of Neurology, Pasar Rebo District General Hospital, Jakarta
Fatimatuzzuhroh Department of Child Health, Pasar Rebo District General Hospital, Jakarta
Alya Darin Wijaya Department of General Practitioners, Pasar Rebo District General Hospital, Jakarta

https://doi.org/10.33476/ms.v12i2.5831

Keywords:

Hyponatremia, Tuberculous Meningitis, Pediatric, Mortality

Abstract

Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis caused by hematogenous dissemination of Mycobacterium tuberculosis to the meninges. MTB crosses brain protective barriers, creating subependymal collections known as rich foci. Rupture of these foci triggers severe inflammatory responses and meningitis. TBM carrying substantially high rates of morbidity and mortality. Hyponatremia has been linked with adverse clinical outcomes; although the existing evidence in pediatric population remains inconclusive. A retrospective cohort study was conducted at Pasar Rebo General Public Hospital, Jakarta, Indonesia from January 2021 to March 2024. Children aged 0–18 years hospitalized with meningitis and bacteriologically confirmed tuberculosis wereincluded. A total of 26 childrenmet the inclusion criteria. Hyponatremia was present in 76.9% of patients at initial laboratory assessment and persisted in subsequent evaluations despite corrective measures. The risk of hyponatremia was significantly higher among patients receiving diuretic therapy (RR 1.35; 95% CI, 1.061–1.725). Although hyponatremia was not statistically associated with mortality (RR 1.176; 95% CI, 0.979–1.414; p = 1.000), all deaths occurred exclusively in hyponatremic patients, suggesting its potential prognostic relevance.

References

Ahmad S, Majid Z, Mehdi M, and Mubarak M 2016. Cerebral salt wasting syndrome due to tuberculous meningitis; a case report. J Renal Inj Prev, 5 (1): 53-4. https://doi.org/10.15171/jrip.2016.12. https://www.ncbi.nlm.nih.gov/pubmed/27069970.

Dian S, Ardiansyah E, Chaidir L, Van Laarhoven A, Ruslami R, Alisjahbana B, Rizal Ganiem A, and van Crevel R 2024. Clinical Significance of Hyponatremia in Tuberculous Meningitis: A Prospective Cohort in Indonesia. Open Forum Infect Dis, 11 (12): ofae673. https://doi.org/10.1093/ofid/ofae673. https://www.ncbi.nlm.nih.gov/pubmed/39660022.

Dimyati Y, Tjandradjani A, Mangunatmadja I, Widodo DP, Pusponegoro HD 2011. Outcomes of tuberculous meningitis in children: a case review study. Paediatr Indones, 51: 288-93.

Espay AJ 2014. Neurologic complications of electrolyte disturbances and acid-base balance. Handb Clin Neurol, 119: 365-82. https://doi.org/10.1016/B978-0-7020-4086-3.00023-0. https://www.ncbi.nlm.nih.gov/pubmed/24365306.

Ha C, Ryu JA 2021. Association of Hyponatremia and Clinical Prognosis in Neuro Critically Ill Patients. Journal of Neurointensive Care, 4 (1): 30-5.

Hieu TH, MR Hashan, S Morsy, GM Tawfik, F Cuce, A Sharma, TTH Quynh, HA Faraj, ATA Qarawi, and NT Huy 2021. Hyponatremia in tuberculous meningitis: A systematic review and meta-analysis. Indian J Tuberc, 68 (4): 516-526. https://doi.org/10.1016/j.ijtb.2021.06.004. https://www.ncbi.nlm.nih.gov/pubmed/34752323.

Kirkman MA 2014. Managing hyponatremia in neurosurgical patients. Minerva Endocrinol, 39 (1): 13-26. https://www.ncbi.nlm.nih.gov/pubmed/24513600.

Kirkman MA, AF Albert, A Ibrahim, and D Doberenz 2013. Hyponatremia and brain injury: historical and contemporary perspectives. Neurocrit Care, 18 (3): 406-16. https://doi.org/10.1007/s12028-012-9805-y. https://www.ncbi.nlm.nih.gov/pubmed/23212244.

Kubre J, V Goyal, S Saigal, JP Sharma, and R Joshi 2021. Tuberculous Meningitis Presenting as Cerebral Salt Wasting Syndrome: A Review of Literature with Clinical Approach to Hyponatremia. Neurol India, 69 (1): 190-193. https://doi.org/10.4103/0028-3886.310074. https://www.ncbi.nlm.nih.gov/pubmed/33642300.

Lee SA, and Team 2018. A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis. J Korean Med Sci, 33 (31): e201. https://doi.org/10.3346/jkms.2018.33.e201. https://www.ncbi.nlm.nih.gov/pubmed/30069169.

Marais S, G Thwaites, JF Schoeman, ME Torok, UK Misra, K Prasad, PR Donald, RJ Wilkinson, and BJ Marais 2010. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 10 (11): 803-12. https://doi.org/10.1016/S1473-3099(10)70138-9. https://www.ncbi.nlm.nih.gov/pubmed/20822958.

Misra UK, and J Kalita 2019. Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis. Wellcome Open Res 4: 189. https://doi.org/10.12688/wellcomeopenres.15502.2. https://www.ncbi.nlm.nih.gov/pubmed/32734004.

Misra UK, J Kalita, SK Bhoi, and RK Singh 2016. A study of hyponatremia in tuberculous meningitis. J Neurol Sci, 367: 152-7. https://doi.org/10.1016/j.jns.2016.06.004. https://www.ncbi.nlm.nih.gov/pubmed/27423581.

Na S, T Kim, IU Song, SW Chung, SH Kim, YS Oh, J Oh, and W Kim 2021. The association between serum sodium level and tuberculous meningitis compared with viral and bacterial meningitis. Sci Rep, 11 (1): 10906. https://doi.org/10.1038/s41598-021-90358-5. https://www.ncbi.nlm.nih.gov/pubmed/34035388.

Salih R, R van Toorn, JA Seddon, and RS Solomons 2021. The Impact of Hyponatremia on the Severity of Childhood Tuberculous Meningitis. Front Neurol, 12: 703352. https://doi.org/10.3389/fneur.2021.703352. https://www.ncbi.nlm.nih.gov/pubmed/35069403.

Slane VH, and CG Unakal 2025. Tuberculous Meningitis. In StatPearls. Treasure Island (FL).

Tremblay A, MP Gagne, L Perusse, C Fortier, V Provencher, R Corcuff, S Pomerleau, N Foti, and V Drapeau 2024. Sodium and Human Health: What Can Be Done to Improve Sodium Balance beyond Food Processing?, Nutrients, 16 (8). https://doi.org/10.3390/nu16081199. https://www.ncbi.nlm.nih.gov/pubmed/38674889.

Yang F, Z Cao, X Wang, Z Cui, D Cheng, Z Li, B Lv, H Zhang, P Guo, Y Feng, and W Liu 2021. A multi-parameter study of the etiological diagnosis of hyponatremia after hypothalamic tumor surgery. Clin Neurol Neurosurg 210: 106963. https://doi.org/10.1016/j.clineuro.2021.106963. https://www.ncbi.nlm.nih.gov/pubmed/34715556