Abhilasha Tripathi1, Mritunjai Kumar2, Jayantee Kalita1, Surya Kant3, Usha K Misra4. 1. Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh, India, 226014. 2. Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. 3. Department of Respiratory Medicine, King George's Medical University, Lucknow, India. 4. Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh, India, 226014. drukmisra@rediffmail.com.
Abstract
BACKGROUND: To evaluate serum antidiuretic hormone (ADH), its receptors, and renin levels in cerebral salt wasting (CSW) in tuberculous meningitis (TBM). METHODS: Patients diagnosed with definite (n = 30) or probable TBM (n = 47) who developed hyponatremia (CSW, SIADH, or miscellaneous causes) were included. Sequential measurement of serum ADH, ADH-R, and renin activity by enzyme-linked immunosorbent assay was done and correlated with serum sodium level, urinary output, and fluid balance. RESULTS: Out of 79 TBM patients, CSW was observed in 36, SIADH in four, and miscellaneous hyponatremia in eight patients. CSW patients had a longer hospital stay (P < 0.001), lower GCS score (P < 0.007), higher MRC grade (P < 0.007), and a lower serum Na (P < 0.001) compared to non-CSW TBM patients. In severe CSW patients, serum ADH and ADH-R were correlated with hyponatremia and returned to baseline on correction; however, serum renin levels remained elevated. Serum ADH was related to hyponatremia but ADH-R and renin were not. ADH-R and renin levels did not significantly differ in CSW and SIADH. CONCLUSION: CSW is the commonest cause of hyponatremia in TBM and correlates with disease severity. ADH is related to hyponatremia, but ADH receptor and renin are not.
BACKGROUND: To evaluate serum antidiuretic hormone (ADH), its receptors, and renin levels in cerebral salt wasting (CSW) in tuberculous meningitis (TBM). METHODS: Patients diagnosed with definite (n = 30) or probable TBM (n = 47) who developed hyponatremia (CSW, SIADH, or miscellaneous causes) were included. Sequential measurement of serum ADH, ADH-R, and renin activity by enzyme-linked immunosorbent assay was done and correlated with serum sodium level, urinary output, and fluid balance. RESULTS: Out of 79 TBM patients, CSW was observed in 36, SIADH in four, and miscellaneous hyponatremia in eight patients. CSW patients had a longer hospital stay (P < 0.001), lower GCS score (P < 0.007), higher MRC grade (P < 0.007), and a lower serum Na (P < 0.001) compared to non-CSW TBM patients. In severe CSW patients, serum ADH and ADH-R were correlated with hyponatremia and returned to baseline on correction; however, serum renin levels remained elevated. Serum ADH was related to hyponatremia but ADH-R and renin were not. ADH-R and renin levels did not significantly differ in CSW and SIADH. CONCLUSION: CSW is the commonest cause of hyponatremia in TBM and correlates with disease severity. ADH is related to hyponatremia, but ADH receptor and renin are not.
Authors: E Berendes; M Walter; P Cullen; T Prien; H Van Aken; J Horsthemke; M Schulte; K von Wild; R Scherer Journal: Lancet Date: 1997-01-25 Impact factor: 79.321
Authors: M Cerdà-Esteve; E Cuadrado-Godia; J J Chillaron; C Pont-Sunyer; G Cucurella; M Fernández; A Goday; J F Cano-Pérez; A Rodríguez-Campello; J Roquer Journal: Eur J Intern Med Date: 2008-03-07 Impact factor: 4.487
Authors: Christina Bal; Daniela Gompelmann; Michael Krebs; Lukasz Antoniewicz; Claudia Guttmann-Ducke; Antje Lehmann; Christopher Oliver Milacek; Maximilian Robert Gysan; Peter Wolf; Maaia-Margo Jentus; Irene Steiner; Marco Idzko Journal: PLoS One Date: 2022-10-13 Impact factor: 3.752