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):