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ePublished: 20 Feb 2016
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J Renal Inj Prev. 2016;5(1): 53-54.
doi: 10.15171/jrip.2016.12
PMID: 27069970
PMCID: PMC4827388
  Abstract View: 1507
  PDF Download: 806

Case Report

Cerebral salt wasting syndrome due to tuberculous meningitis; a case report

Syed Ahmad 1, Zain Majid 1 * , Mehwish Mehdi 1, Muhammed Mubarak 2

1 Department of Internal Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
2 Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
*Corresponding author: Zain Majid, Zain88@hotmail.com

Abstract

A 58-year-old male presented with fever, nausea, and vomiting since 15 days along with irritability and confusion since 5 days. His laboratory reports showed low serum sodium, serum osmolality and uric acid. Computerized tomography (CT) scan of brain revealed age-related changes. While on lumbar puncture (LP) and cerebrospinal fluid (CSF) examination, CSF protein, lactate dehydrogenase (LDH) and total leukocyte count (predominant lymphocytes) were all increased. On his 14th day of admission, his serum sodium was 116 mEq/l and he had a high urine output. Fluid restriction was tried in order to rule out syndrome of inappropriate antidiuretic hormone secretion (SIADH) but the patient did not respond to it. Keeping in view the above findings, a final diagnosis of tuberculous meningitis leading to cerebral salt wasting syndrome was made. The patient was started on 3% hypertonic saline, mineralocorticoids and anti-tuberculous therapy (ATT), to which he responded favorably and was later discharged.
Keywords: Cerebral salt wasting syndrome, Hyponatremia, Tuberculosis meningitis, SIADH

Implication for health policy/practice/research/medical education:

Cerebral salt wasting syndrome is one of the under-recognized causes of hyponatremia and is often confused with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. It is essential to differentiate the syndrome from SIADH as the management of both conditions is drastically different but their presenting features overlap.

Please cite this paper as: Ahmad S, Majid Z, Mehdi M, Mubarak M. Cerebral salt wasting syndrome due to tuberculous meningitis; a case report. J Renal Inj Prev. 2016;5(1):53-54. DOI: 10.15171/jrip.2016.12

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