D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
567
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
EPIDEMIOLOGICAL PROFILE AND PREVALENCE OF HYPONATREMIA IN
PULMONARY TUBERCULOSIS: A CROSS-SECTIONAL STUDY FROM RAJASTHAN,
INDIA
D Ami Kuma 1, D Gulab Singh Yada 2, D Ji end a Kuma Sha ma3
1 Junio Residen , Depa men o Respi a o y Medicine, Ins i u e o Respi a o y Disease, SMS Medical College, Jaipu
2 P o esso , Depa men o Respi a o y Medicine, Ins i u e o Respi a o y Disease, SMS Medical College, Jaipu
3 Assis an P o esso , Ins i u e o Respi a o y Diseases, SMS Medical College, Jaipu
A B S T R A C T
Co esponding Au ho :
D Ji end a Kuma Sha ma
Assis an P o esso , Ins i u e o
Respi a o y Diseases, SMS Medical
College, Jaipu .
Recei ed: 09-10-2025
Accep ed: 14-11-2025
A ailable online: 20-11-2025
Backg ound: Hypona emia is one o he mos common elec oly e dis u bances
seen in hospi alized pulmona y ube culosis (PTB) pa ien s and may e lec disease
se e i y. Indian da a a e limi ed, pa icula ly om high-bu den s a es such as
Rajas han.
Objec i es: To de e mine he p e alence and se e i y o hypona emia in newly
diagnosed spu um smea –posi i e pulmona y ube culosis pa ien s and o desc ibe
hei demog aphic and clinical p o ile.
Me hods: This desc ip i e c oss-sec ional s udy was conduc ed in he Depa men
o Respi a o y Medicine, Ins i u e o Respi a o y Diseases, e ia y ca e hospi al in
Rajas han. A o al o 140 newly diagnosed spu um smea –posi i e PTB pa ien s
we e included o e one yea . Se um sodium le els we e measu ed a diagnosis and
ca ego ized as mild (130–134 mmol/L), mode a e (125–129 mmol/L), and se e e
(<125 mmol/L). Sociodemog aphic and clinical pa ame e s we e eco ded and
analyzed.
Resul s: The p e alence o hypona emia (<135 mmol/L) was 45%. Se e e
hypona emia was seen in 10%, mode a e in 14%, and mild in 21% o pa ien s.
Mos pa icipan s we e aged 41–60 yea s (53.6%), male (80.7%), and om u al
a eas (90%). A s a is ically signi ican associa ion was obse ed be ween se um
sodium and age g oup (p = 0.00001), gende (p = 3.35×10⁻⁵), BMI (p = 6.22×10⁻⁴),
occupa ion (p = 2.36×10⁻⁴), ches X- ay indings (p = 6.12×10⁻⁴), and spu um AFB
g ading (p = 0.02).
Conclusion: Hypona emia is highly p e alen in PTB pa ien s, pa icula ly among
emales, unde weigh indi iduals, and hose wi h ad anced adiological and
bac e iological disease. Rou ine sodium moni o ing is ecommended o ea ly
de ec ion and managemen .
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Hypona emia, Pulmona y Tube culosis, P e alence, Epidemiology,
Rajas han, SIADH.
INTRODUCTION
Tube culosis (TB) emains a global heal h challenge, wi h India accoun ing o 28 % o inciden cases. Among he
a ious complica ions associa ed wi h TB, hypona emia is one o he mos common elec oly e abno mali ies
encoun e ed in clinical p ac ice. I s mechanisms include he synd ome o inapp op ia e an idiu e ic ho mone sec e ion
(SIADH), ad enal insu iciency, cen al ne ous sys em in ol emen , and enal sodium loss. Repo ed p e alence a ies
om 8 % o 49 % in di e en Indian s udies. Rajas han, a high-TB-bu den s a e, lacks adequa e da a on his opic. This
s udy was designed o de e mine he p e alence and se e i y o hypona emia in PTB pa ien s and desc ibe hei clinico-
epidemiological p o ile.
MATERIALS AND METHODS
S udy Design and Se ing: Hospi al-based desc ip i e c oss-sec ional s udy conduc ed in he Depa men o Respi a o y
Medicine, Ins i u e o Respi a o y Diseases, e ia y ca e hospi al in Rajas han
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
568
S udy Du a ion:One yea . Sample Size:140 pa ien s, calcula ed assuming a 40 % p e alence o hypona emia, 95 %
con idence le el, and 9 % allowable e o .
Inclusion C i e ia:
1. Adul s ≥18 yea s
2. Newly diagnosed spu um smea –posi i e, d ug-sensi i e PTB
3. P o ided in o med consen
Exclusion C i e ia:
1. HIV-posi i e pa ien s
2. Pa ien s on d ugs a ec ing sodium me abolism
3. P egnan emales
4. Ch onic ca diac, enal, o hepa ic disease
Da a Collec ion: Demog aphic, clinical, and adiological da a we e collec ed using a s uc u ed p o o ma. Se um sodium
was measu ed using s anda d biochemical me hods.
S a is ical Analysis: SPSS was used. Quan i a i e da a we e p esen ed as mean ± SD. Ca ego ical da a we e exp essed
as equencies and pe cen ages. Chi-squa e es and - es s we e applied; p < 0.05 was conside ed signi ican .
RESULTS
The age dis ibu ion able (Table 1) o he s udy pa icipan s shows ha he majo i y belong o he 41–60 yea s age
g oup, which cons i u es 53.85% (75) o he o al sample. This is closely ollowed by he 21–40 yea s age g oup,
accoun ing o 27.85% (39). Pa icipan s aged abo e 60 yea s make up 19.28% (21), while hose unde 20 yea s a e he
leas ep esen ed, wi h only 3.57% (5 pa icipan s). This indica es ha he sample is p edominan ly comp ised o adul s
aged 21 o 60 yea s, wi h ela i ely ewe pa icipan s om he younge (<20 yea s) and olde (>60 yea s) age g oups.
Such a dis ibu ion sugges s ha he s udy p ima ily e lec s indings ele an o he adul and middle-aged popula ion
The gende dis ibu ion able (Table 2) indica es a ma ked male p edominance among he s udy pa icipan s. Ou o he
o al 140 subjec s, 113 (80.71%) a e male and only 27 (19.28%) a e emale. This signi ican dispa i y sugges s ha males
cons i u e he majo i y o he sample, and any indings o he s udy may p ima ily e lec he cha ac e is ics and
ou comes o he male popula ion.
The able 3 p esen s he dis ibu ion o se um sodium le els among a o al o 140 indi iduals. I e eals ha 10% o he
pa icipan s had se um sodium le els below 125 mmol/L, indica ing se e e hypona emia. An addi ional 14% had
sodium le els be ween 125–129 mmol/L (mode a e hypona emia), while 21% had le els anging om 130–134 mmol/L
(mild hypona emia). Thus, a o al o 45% o he s udy popula ion exhibi ed some deg ee o hypona emia. The
emaining 55% o indi iduals had se um sodium le els g ea e han 135 mmol/L, which is conside ed wi hin he no mal
ange. This sugges s ha hypona emia is a ela i ely common biochemical abno mali y in he s udy popula ion, wi h a
signi ican p opo ion exhibi ing mild o mode a e sodium de iciency.
The able 4 demons a es a s a is ically signi ican associa ion be ween age g oup and se um sodium le els. Se e e
hypona emia (<125 mmol/L) and mode a e hypona emia (125–129 mmol/L) we e mos p e alen in he younges age
g oup (<20 yea s), whe e all indi iduals had low sodium le els. In con as , he 21–40 y g oup showed a mixed pa e n,
wi h some indi iduals ha ing low sodium and a majo i y main aining no mal le els. The 41–60 y g oup had he highes
p opo ion o no mal o mildly low sodium le els, indica ing g ea e elec oly e s abili y in middle age. Howe e , he >60
y g oup again showed a highe equency o hypona emia, e lec ing inc eased ulne abili y in elde ly indi iduals.
O e all, hese indings highligh ha bo h he younges and oldes age g oups a e mo e p one o hypona emia, while
middle-aged indi iduals exhibi ela i ely be e sodium balance.
The able 5 shows a s a is ically signi ican associa ion be ween gende and se um sodium le els. Among emales, he
majo i y had low se um sodium le els, wi h only 4 ou o 27 (14.8%) ha ing alues abo e 135 mmol/L, whe eas among
males, 73 ou o 113 (64.6%) had no mal sodium le els. Con e sely, hypona emia (se um sodium <135 mmol/L) was
much mo e p e alen in emales (85.2%) compa ed o males (35.4%). This signi ican dispa i y indica es ha emale
pa ien s in he s udy we e a mo e likely o p esen wi h low se um sodium le els, sugges ing a po en ial gende - ela ed
physiological o clinical suscep ibili y.
The able 6 illus a es he ela ionship be ween como bidi y s a us and se um sodium le els, wi h he Chi-squa e es
esul indica ing no s a is ically signi ican associa ion. Among pa ien s wi h diabe es, he majo i y had no mal se um
sodium le els (>135 mmol/L), while a subs an ial numbe exhibi ed a ying deg ees o hypona emia. Simila ly, in
hype ensi e indi iduals, 24 ou o 47 had no mal sodium le els, and 23 had le els below 135 mmol/L. In he g oup
wi hou any como bidi ies, mos pa icipan s had no mal sodium le els, wi h ewe cases o hypona emia. Al hough
hypona emia appea s mo e equen among hose wi h como bidi ies, he obse ed di e ences ac oss he g oups we e
no s a is ically signi ican .
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
569
The able 7 shows a s a is ically signi ican associa ion be ween BMI and se um sodium le els. Among unde weigh
indi iduals a la ge p opo ion had hypona emia, wi h 35 ou o 56 (62.5%) showing sodium le els below 135 mmol/L.
In con as , no mal-weigh indi iduals had a mo e balanced dis ibu ion, wi h 56 ou o 80 (70%) ha ing no mal sodium
le els (>135 mmol/L). In e es ingly, among o e weigh indi iduals (BMI 25–29.9), all had some deg ee o
hypona emia, wi h none ha ing se um sodium abo e 135 mmol/L. These indings indica e ha bo h ex emes o BMI —
unde weigh and o e weigh — may be associa ed wi h highe isk o hypona emia, whe eas indi iduals wi h no mal
BMI end o ha e mo e s able sodium le els.
The able 8 shows a s a is ically signi ican associa ion be ween occupa ion and se um sodium le els. Among he no
skilled g oup, a high p opo ion had hypona emia, wi h only 7 ou o 28 indi iduals (25%) ha ing no mal sodium le els.
In con as , he semi-skilled g oup showed a heal hie sodium p o ile, wi h 60 ou o 80 (75%) ha ing no mal le els. The
skilled and p o essional g oups had mo e balanced o mildly skewed dis ibu ions bu s ill showed no able a iabili y in
sodium le els. These di e ences sugges ha occupa ion, po en ially e lec ing di e ences in socio-economic s a us,
nu i ional access, o disease se e i y, has a signi ican impac on se um sodium le el
The able 9 p esen s he dis ibu ion o se um sodium le els based on esidence and shows no s a is ically signi ican
associa ion be ween he wo a iables (Chi-squa e = 5.09, d = 3, p = 0.165). Among u al esiden s, he majo i y (73 ou
o 126) had no mal se um sodium le els (>135 mmol/L), while 53 had a ying deg ees o hypona emia. In con as ,
u ban esiden s showed a ela i ely e en dis ibu ion ac oss sodium ca ego ies, wi h no s ong concen a ion in any
speci ic ange. Al hough hypona emia (<135 mmol/L) appea s mo e common in u al esiden s nume ically, he
di e ence was no s a is ically signi ican , sugges ing ha esidence ( u al s u ban) does no ha e a meaning ul
impac on se um sodium le els in his s udy popula ion
The able 10 p esen s a s a is ically signi ican associa ion be ween ches X- ay indings and se um sodium le els (Chi-
squa e = 17.30, DF = 3, p = 6.12 × 10⁻⁴). Among pa ien s wi h consolida ion, he majo i y (75 ou o 128) had no mal
se um sodium le els (>135 mmol/L), while only a small p opo ion had se e e hypona emia. In con as , among hose
wi h ib o-ca i y lesions, mos indi iduals (10 ou o 12) had se um sodium le els <135 mmol/L, including 4 pa ien s
wi h sodium <125 mmol/L. This ma ked dispa i y indica es ha pa ien s wi h ib o-ca i a y lesions a e signi ican ly
mo e p one o hypona emia compa ed o hose wi h simple consolida ion.
The able 11 shows a s a is ically signi ican associa ion be ween spu um AFB g ading and se um sodium le els (Chi-
squa e = 15.02, DF = 6, p = 2.01 × 10⁻²). Among pa ien s wi h G ade 1 AFB, he majo i y (22 ou o 26) had no mal
se um sodium le els (>135 mmol/L), wi h e y ew showing hypona emia. In con as , hose wi h G ade 2 and G ade 3
AFB had a p og essi ely highe p opo ion o low se um sodium le els, especially in he <125 and 125–129 mmol/L
ca ego ies. No ably, G ade 3 cases accoun ed o 11 o he 14 pa ien s wi h se e e hypona emia (<125 mmol/L). This
end sugges s ha inc easing AFB g ade, which indica es highe mycobac e ial load, is associa ed wi h g ea e
likelihood o hypona emia, po en ially e lec ing mo e se e e sys emic in ol emen o disease bu den.
TABLE NO. 1 : DISTRIBUTION OF STUDY PARTICIPANTS AS PER AGE
VARIABLES
FREQUENCY
PERCENTAGE %
< 20 YR
5
3.57%
21- 40 YR
39
27.85%
41 - 60 YR
75
53.57%
> 60 YR
21
19.28%
TOTAL
140
100%
TABLE NO. 2: DISTRIBUTION OF STUDY PARTICIPANTS AS PER GENDER
Va iables
F equency
Pe cen age %
Female
27
19.28%
Male
113
80.71%
G and To al
140
100%
TABLE NO.3: DISTRIBUTION OF STUDY PARTICIPANTS AS PER SERUM SODIUM LEVEL
Va iables
F equency
Pe cen age%
<125
14
10 %
125-
129
19
14 %
130-
134
30
21%
>
135
77
55%
G and
To al
140
100%
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
570
TABLE NO.4: ASSOCIATION OF SERUM SODIUM WITH AGE GROUP
VARIABLE
SERUMSODIUM
AGEGROUP
<125
125-129
130-134
>135
TOTAL
<20 YR
4
1
0
0
5
21-40YR
5
5
4
25
39
41-60YR
3
8
20
44
75
>60 YR
2
5
6
8
21
TOTAL
14
19
30
77
140
CHISQAURE VALUE = 39.19DF= 9 P-VALUE=0.00001 SIGNIFICANT
TABLE NO.5: ASSOCIATION OF SERUM SODIUM WITH GENDER
VARIABLE
SERUMSODIUM
GENDER
<125
125-129
130-134
>135
TOTAL
FEMALE
6
8
9
4
27
MALE
8
11
21
73
113
TOTAL
14
19
30
77
140
CHISQAURE VALUE = 23.39 DF= 3 P-VALUE=3.35 × 10⁻⁵S I G N I F I C A N T
VARIABLE
SERUMSODIUM
SPUTUMAFB
<125
125-129
130-134
> 135
TOTAL
GRADE1
0
1
3
22
26
GRADE2
3
5
12
18
38
GRADE3
11
13
15
37
76
TOTAL
14
19
30
77
140
CHISQAUREVALUE= 15.02DF= 6 P-VALUE= 2.01 × 10⁻²SIGNIFICANT
TABLE NO. 6: ASSOCIATION OF SERUM SODIUM WITH COMORBIDITY
Va iables
Sodiumse umle el
<125
125-129
130-134
> 135
TOTAL
Diabe es
7
6
18
35
66
Hype ension
5
8
10
24
47
4532
14
1585
19
04
20
6
30
0
25
44
8
77
0
10
20
30
40
50
60
70
80
90
<20 YR 21-40 YR 41-60 YR >60 YR TOTAL
ASSOCIATION OF SERUM SODIUM WITH AGE GROUP
SERUM SODIUM <125 SERUM SODIUM 125-129 SERUM SODIUM 130-134 SERUM SODIUM >135
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
571
Don’ Ha eAny
2
5
2
10
27
G and
To al
14
19
30
77
140
Chi-squa e = 6.48DF=.6 p alue=0.372 NOTSIGNIFICANT
TABLE NO.7: ASSOCIATION OF SERUM SODIUM WITH BODY MASS INDEX
Va iables
Se um
sodium
BMI
<125
125-129
130-134
> 135
TOTAL
<18.5
7
10
18
21
56
No malweigh 18.5–24.9
5
8
11
56
80
O e weigh 25–29.9
2
1
1
0
4
G and
To al
14
19
30
77
140
Chisqua e= 23.59 DF= 6 PVALUE=6.22 × 10⁻⁴ SIGNIFICANT
TABLE NO.8: ASSOCIATION OF SERUM SODIUM WITH OCCUPATION
VARIABLE
SERUMSODIUM
OCCUPATION
<125
125-129
130- 134
> 135
TOTAL
NOT SKILLED
5
7
9
7
28
SEMISKILLED
4
5
11
60
80
SKILLED
3
5
6
7
21
PROFESIONAL
2
2
4
3
5
TOTAL
14
19
30
77
140
CHISQAURE VALUE = 31.58 DF= 9 P-VALUE= 2.36 × 10⁻⁴ SIGNIFICANT
TABLE NO.9: ASSOCIATION OF SERUM SODIUM WITH DOMICILE
TABLE NO.10: ASSOCIATION OF SERUM SODIUM WITH CHEST X RAY
VARIABLE
SERUMSODIUM
CHESTX-RAY
<125
125-129
130-134
> 135
TOTAL
CONSOLIDATION
10
15
28
75
128
FIBROCAVITYLESSION
4
4
2
2
12
TOTAL
14
19
30
77
140
CHISQAURE VALUE = 17.30 DF= 3 P-VALUE= 6.12 × 10⁻⁴ SIGNIFICANT
TABLE NO.11: ASSOCIATION OF SERUM SODIUM WITH SPUTUM AFB
VARIABLE
SERUMSODIUM
SPUTUMAFB
<125
125-129
130-134
> 135
TOTAL
GRADE1
0
1
3
22
26
GRADE2
3
5
12
18
38
GRADE3
11
13
15
37
76
TOTAL
14
19
30
77
140
CHISQAUREVALUE= 15.02DF= 6 P-VALUE= 2.01 × 10⁻²SIGNIFICANT
DISCUSSION
Demog aphic and Socioeconomic P o ile
In he p esen s udy, we analyzed 140 adul pa ien s diagnosed wi h pulmona y ube culosis (PTB), wi h a p ima y ocus
on e alua ing he p e alence, se e i y, and clinical associa ions o hypona emia. The majo i y o pa icipan s belonged
VARIABLE
SERUMSODIUM
RESIDENCE
<125
125-129
>130-134
>135
TOTAL
RURAL
11
16
26
73
126
URBAN
3
3
4
4
14
TOTAL
14
19
30
77
140
CHISQAURE VALUE =5.09 DF= 3 P-VALUE=0.165 NOTSIGNIFICANT
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
572
o he 41–60 yea s age g oup (53.57%), ollowed by hose aged 21–40 yea s (27.85%), wi h a mino ep esen a ion om
he <20 yea s and >60 yea s ca ego ies. The s udy popula ion showed a p onounced male p edominance (80.71%) and
u al esidence (90%), e lec ing he demog aphic pa e n ypical o TB bu den in low- esou ce se ings in India. Mos
pa ien s we e semi-skilled wo ke s (61.4%), and only a small p opo ion (3.6%) we e p o essionals, highligh ing
socioeconomic ulne abili y as a con ibu ing ac o in TB epidemiology.
This demog aphic p o ile is in line wi h p e ious s udies. Fo ins ance, Sinha P. e al. (2023) [3] also epo ed a male
majo i y (74%) among 150 PTB pa ien s, while Dash M. e al. (2020)[4] no ed ha males accoun ed o 42% o
hypona emic cases. Simila ly, Upadhyay A. e al. (2006)[5] desc ibed a highe male p e alence and s essed he
associa ion be ween lowe socioeconomic s a a and inc eased TB bu den
P e alence and Se e i y o Hypona emia
Hypona emia, de ined as a se um sodium le el below 135 mmol/L, was obse ed in 45% o ou s udy popula ion.
Se e e hypona emia (<125 mmol/L) occu ed in 10% o cases, highligh ing i s ele ance as a common and clinically
impo an biochemical abno mali y among PTB pa ien s. These indings a e compa able wi h p io li e a u e, including
Sinha P. e al. (2023[3]), who epo ed a 76% p e alence o hypona emia in PTB pa ien s, and Shwe ha M.S. e al.
[6](2019), who ound ha 76% o pa ien s had hypona emia, ca ego ized as mild (39%), mode a e (27%), o se e e
(9%).
The consis ency ac oss s udies unde lines ha hypona emia is no only p e alen in PTB bu can ange in se e i y and
o en goes un ecognized due o i s subclinical p esen a ion. Ou indings ea i m he need o ou ine sodium e alua ion
as pa o PTB wo kup
S a is ical Associa ions wi h Se um Sodium
Ou s udy iden i ied s a is ically signi ican associa ions be ween se um sodium le els and mul iple a iables:
• Age G oup (p = 0.00001): Hypona emia was mo e p e alen among he younges (<20 yea s) and oldes (>60
yea s) pa ien s. Ja a i N. e al. (2012)[7] simila ly epo ed a highe isk o hypona emia in elde ly pa ien s (P =
0.047).
• Gende (p = 3.35 × 10⁻⁵): Female pa ien s had a highe likelihood o de eloping hypona emia. This is consis en
wi h he gende s a i ica ion in Sinha P. e al. 2023[3] and Ja a i N.e al. 2012’s[7] s udies, al hough hei indings
sugges ed male p edominance; his disc epancy may poin o egional, gene ic, o nu i ional di e ences.
• BMI (p = 6.22 × 10⁻⁴): Bo h unde weigh and o e weigh indi iduals had highe a es o hypona emia compa ed o
hose wi h no mal BMI. This e lec s he dual bu den o malnu i ion and ch onic disease in TB pa ien s.
• Occupa ion (p = 2.36 × 10⁻⁴): Unskilled wo ke s showed he highes equency o low sodium, ein o cing he
associa ion be ween poo socioeconomic s a us and disease bu den.
• Ches X- ay Findings (p = 6.12 × 10⁻⁴): Pa ien s wi h ib oca i a o y lesions exhibi ed signi ican ly mo e
hypona emia han hose wi h simple consolida ion.
• Spu um AFB G ade (p = 2.01 × 10⁻²): A clea end was obse ed, wi h highe AFB g ades co ela ing wi h mo e
se e e hypona emia.
These associa ions emphasize he mul i ac o ial e iology o hypona emia in PTB, including nu i ional de iciencies,
ch onic disease s ess, and ad anced pulmona y pa hology.
No s a is ically signi ican associa ion was ound be ween se um sodium le els and como bidi y s a us (p = 0.372) o
esidence (p = 0.165). Al hough pa ien s wi h diabe es and hype ension ended o ha e lowe sodium le els, hese
indings did no achie e s a is ical signi icance. This is pa ially co obo a ed by he indings o Ja a i N.e al. 2012[7],
who ound no associa ion be ween hypona emia and como bidi ies. Howe e , Sinha e al. did sugges a mild associa ion
be ween hypona emia and ch onic illness, indica ing he need o la ge mul icen ic s udies o con i m his end.
Pa hophysiology and Mechanisms
Se e al mechanisms ha e been p oposed o explain hypona emia in PTB:
• Synd ome o Inapp op ia e An idiu e ic Ho mone Sec e ion (SIADH): As no ed by Lee P. e al. (2010)[8],
SIADH is a common cause o hypona emia in pulmona y in ec ions, including TB.
• Ad enal Insu iciency: Addison’s disease seconda y o ube cula ad enali is emains an impo an cause, especially
in endemic egions. Dab owski A. e al. (2009)[9] de ailed how ad enal TB can lead o se e e elec oly e
dis u bances.
• CNS In ol emen (e.g., TBM): Dian S. e al. (2024)[10] and Ande son NEe al. (2010) [11] bo h ound high
a es o hypona emia in TB meningi is, ypically due o ce eb al sal was ing o SIADH. Ou s udy did no include
pa ien s wi h CNS TB, bu he indings ein o ce he b oade ele ance o sodium imbalance ac oss TB
mani es a ions.
D Ami Kuma e al. Epidemiological P o ile and P e alence O Hypona emia In Pulmona y Tube culosis: A C oss-
Sec ional S udy F om Rajas han, India. In . J Med. Pha m. Res., 6 (6): 567‐573, 2025
573
Clinical Implica ions
The high p e alence and signi ican associa ions iden i ied in his s udy unde sco e he clinical impo ance o de ec ing
and managing hypona emia in PTB. Se e e hypona emia was mos equen among unde weigh pa ien s, emales, and
hose wi h G ade 3 AFB, e lec ing ad anced disease and poo nu i ional s a us. These insigh s a e impo an o bo h
p ognosis and ea men planning.
While some li e a u e (Dian S. e al. 2024)[10] sugges s ha agg essi e co ec ion o hypona emia may no
independen ly imp o e ou comes in CNS TB, ou indings in PTB sugges ha imely ecogni ion and managemen may
educe mo bidi y. This is u he emphasized by he obse a ion in Sinha P.[3] ha ou pa ien s equi ed asop esso
suppo , highligh ing he po en ial o li e- h ea ening complica ions. The 45 % p e alence o hypona emia in ou s udy
aligns wi h epo s om o he Indian cen e s (18 – 49 %). Female gende , malnu i ion (low BMI), ad anced adiological
indings, and highe AFB smea g ades we e key co ela es, unde sco ing he ole o disease se e i y and hos ac o s.
CONCLUSION
Hypona emia is a equen biochemical abno mali y in PTB pa ien s in Rajas han. Sc eening and ea ly managemen can
p e en complica ions, especially in ulne able g oups such as emales, unde weigh indi iduals, and pa ien s wi h
ad anced disease. Mechanis ically, SIADH is a majo con ibu o in PTB, ollowed by ad enal in ol emen and enal
losses. Clinically, hypona emia is associa ed wi h longe hospi al s ay, inc eased ICU admissions, and highe mo ali y.
Ou indings ein o ce he need o ou ine sodium es ima ion a diagnosis o de ec subclinical dis u bances.
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