DOI: https://doi.org/10.53350/pjmhs20221612388 ORIGINAL ARTICLE 388 P J M H S Vol. 16, No. 12, December, 2022 Frequency of Hyponatremia in Tuberculous Meningitis Patients IFTIKHAR ALI KAKAR 1 , NASIR AZIM 2 , ABDUL BAQI 3 , KIRAN GHAFOOR 4 , NIMRA HAYAT 5 , KHALID SHAHAB 6 , MUHAMMAD IDREES 7 , HIRA QAMAR 8 1 Pulmonologist, Senior Lecturer, Director Department of Medical Education, Bolan Medical College Quetta 2 Assistant professor, Pulmonologist, Fatima Jinnah institute of chest Diseases Quetta 3 Assistant professor, Pulmonologist, Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex 4 Department: Microbiology and Molecular Genetics, University of Okara 5 Department of Microbiology and Molecular Genetics, Faculty of Life Sciences, University of Okara 6 Assistant Professor Medical C Unit, Hayatabad Medical Complex, Peshawar 7 Department of Microbiology and Molecular Genetics, University of Okara 8 Department of Microbiology and Molecular Genetics, University of okara Corresponding author: Khalid Shahab, Email: dr.khalidshahab@gmail.com ABSTRACT Back Ground: A severe inflammation of the meninges is often referred to as meningitis. Hyponatremia has been associated with tuberculous meningitis in numerous studies. Objective: To assess the frequency of hyponatremia in tuberculous meningitis patients Methodology: This cross sectional study was carried out at the department of Neurology Bolan Medical Complex Hospital, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta for duration of one year from September 2021 to September 2022. All the required data like name, gender and presence or absence of hyponatremia were documented in a special proforma designed for this research. Data analysis was carried out by using SPSS version 23. Results: In our study, totally 210 patients were included. The male participants in our study were 94 (44.76%) while female participants were 116 (55.24%). The mean sodium level in serum was observed to be 133 with SD of ± 4.29. The overall frequency of hyponatremia in tuberculous meningitis patients was 113 (53.81%). Conclusion: Our study concludes that the frequency of hyponatremia in tuberculous meningitis patients was very high (53.81%). Hyponatremia may have serious implications, including serious neurological problems and death, if it is not properly diagnosed and treated early Keywords: Frequency, hyponatremia, tuberculous meningitis INTRODUCTION A severe inflammation of the meninges is often referred to as meningitis. Infectious meningitis is classified into three types based on the type of microorganism as bacterial, viral and fungal meningitis 1 . It is unclear how often meningitis occurs, despite the fact that it is a reportable condition in many nations. It is projected that 420,000 fatalities occurred as of 2010 2 . A serious variation of extra-pulmonary tuberculosis is tuberculous meningitis. It is to be anticipated that the incidence rate will be correspondingly high in nations that have a higher incidence of pulmonary tuberculosis 3 . Numerous immediate and long-term problems are connected to meningitis. Hyponatremia, which is characterized as a blood sodium content of less < 135 mEq/L, is one of the acute consequences 4 . In patients being treated in hospitals, it is the most typical electrolyte imbalance. Osmotic demyelination syndrome is one of the neurological problems that may result from improper care of hyponatremia. ADH plays a major part in the pathophysiology of hyponatremia since the majority of instances of hyponatremia are caused by imbalance in water and improper water handling rather than imbalance of sodium. Hyponatremia may cause symptoms including nausea, vomiting, confusion, headache, lethargy, weariness, lack of appetite, irritability, restlessness, cramps or spasms, seizures, and diminished awareness or coma 5 . Due to the fact that all of these symptoms may also appear in meningitis by themselves, it is challenging from a medical perspective to ascribe these symptoms to hyponatremia. For this reason, it is crucial to serially examine the serum electrolytes to exclude hyponatremia since it might result in edema and hyponatremic encephalopathy. Tentorial herniation may result from this. The goal of the present investigation is to ascertain the prevalence of hyponatremia in tuberculous meningitis in the local adult community since the majority of investigations have been conducted in children. The objective of the research is to draw attention to the problem since hyponatremia is one of the factors that might contribute to the worsening of this medical problem. This research will assist us in gathering regional data that measure the scope of the issue. The findings of this research will be helpful in planning how to treat patients with electrolyte abnormalities in general and hyponatremia in particular, with the goal of lowering mortality and morbidity associated with hyponatremia. MATERIALS AND METHODS This cross sectional study was carried out at the department of department of Neurology, Bolan Medical Complex Hospital, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta. The study duration was one year from September 2021 to September 2022. The overall sample size was 210 by using WHO sample size calculator and by taking 5% margin of error, 95% confidence interval, taking expected percentage of hyponatremia in meningitis patients as 49%. Inclusion criteria:  All cases of tuberculous meningitis based on clinical features and CSF routine examination  Either gender  Age range 15 to 60 years  Patients willing to participate in our study Exclusion criteria:  Patients who were having other possible causes of hyponatremia like heart failure, cirrhotic patients, nephritic syndrome and other fluid over load states  Patients who are already on diuretics  Patients not willing to participate in our study Data collection: The data collection was started after proper approval from ethical committee of the hospital. All diagnosed cases of meningitis were screened for hyponatremia from day of admission to the day of discharge and GCS plus other clinical parameters e.g. headache, vomiting, confusion, impaired consciousness and seizures etc were recorded. All the required data like name, gender and presence or absence of hyponatremia were documented in a special proforma designed for this research. Data analysis: Data analysis was carried out by using SPSS version 23. For age and sodium level, Mean ± SD was computed whereas for gender and hyponatremia frequencies and percentages were calculated.