DISCUSSION:
The most typical presentation of tuberculosis (TB), an ancient human
disease caused by the bacteria, Mycobacterium tuberculosis is
respiratory symptoms [3]. But TB presents itself in a variety of
ways since it affects multiple systems. The respiratory system,
gastrointestinal (GI) system, lymphoreticular system, skin, central
nervous system, musculoskeletal system, reproductive system, and liver
are the organ systems most frequently impacted [4,5]. In this case
report, we describe a patient presenting with severe hyponatremia in the
context of pulmonary tuberculosis.
A serum sodium content of less than 135 mEq/L is considered
hyponatremia, albeit this definition may vary slightly depending on the
standards used by different laboratories. A frequent electrolyte
disorder known as hyponatremia is brought on by an excess of total body
water in comparison to total body sodium concentration. A ratio
imbalance known as hyponatremia occurs when the body’s total water
content exceeds its total solute content. The two primary compartments
of total body water (TBW) are extracellular fluid (ECF), which makes up
one-third, and intracellular fluid (ICF), which makes up the other
two-thirds. ECF’s main solute is sodium, while ICF’s main solute is
potassium [6].
A Study in 1969 by Chung et al, demonstrated that 11% of patients with
active TB had Hyponatremia and the main cause was SIADH [7].
Cockcroft et al., reported a 74-year-old woman with miliary tuberculosis
which had been complicated by severe hyponatremia due to SIADH [8].
Lee et al reported an unusual case of PTB presenting as Hyponatremia
with biochemical evidence of ectopic antidiuretic hormone production as
a possible mechanism causing hyponatremia [9].
A few similar cases in the literature are described below (Table 2):