Persistent hypernatremia in tuberculous meningitis- diagnostic dilemma.

Abstract

Hyponatremia has been recognized as a serious complication in patients with tuberculous meningitis (TBM). The differential diagnoses of hyponatremia in TBM are adrenal insufficiency, Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) secretion, and Cerebral Salt Wasting Syndrome (CSWS). Thorough clinical and laboratory examination is important to distinguish between SIADH and CSWS as attention to extracellular volume status is critical. Misdiagnosis of CSWS as SIADH can be fatal, as water restriction is detrimental to patients with CSWS.