Electrolyte Imbalances in Newly Diagnosed Pulmonary Tuberculosis Patients and Reversibility with Treatment
Main Article Content
Abstract
Background: Electrolyte imbalances are commonly observed in pulmonary tuberculosis patients but remain under-reported in clinical practice. These disturbancesinvolving sodium, potassium, chloride and bicarbonate - can exacerbate disease severity and delay recovery.
Objectives: To evaluate the prevalence, pattern and reversibility of serum electrolyte disturbances in newly diagnosed pulmonary tuberculosis patients compared to healthy controls at a tertiary care hospital in India.
Methodology: This observational study enrolled 250 newly diagnosed pulmonary tuberculosis patients and 50 age- and sex-matched healthy controls. Serum sodium, potassium, chloride and bicarbonate levels were measured at baseline using standardized methods. A subset of 100 tuberculosis patients was re-evaluated after four months of antitubercular therapy. Data analysis was performed using SPSS v28.0; p-values <0.05 were considered statistically significant.
Results: Tuberculosis patients had significantly lower levels of sodium (127.7 ± 3.9 vs. 140.4 ± 3.3 mmol/L), potassium (3.6 ± 0.7 vs. 4.2 ± 0.5 mmol/L), and chloride (99.8 ± 7.6 vs. 101.9 ± 6.1 mmol/L) than controls (p<0.001). Hyponatremia affected 48.8% of tuberculosis patients, hypokalemia 34.4%, and hypocarbonemia 36.0%. Post-treatment, sodium and potassium levels normalized significantly (p<0.001) and indicated reversibility.
Conclusion: Electrolyte imbalances – such as hyponatremia and hypokalemia - were common in tuberculosis patients and showed significant improvement with treatment. Routine electrolyte monitoring should be integrated into tuberculosis care to reduce complications and improve outcomes.
Keywords:
Tuberculosis, Pulmonary, Electrolyte Imbalance, Hyponatremia, Hypokalemia, Acid-Base Imbalance
Article Details
How to Cite
DASH, Om Padarabinda et al.
Electrolyte Imbalances in Newly Diagnosed Pulmonary Tuberculosis Patients and Reversibility with Treatment.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6683>. Date accessed: 08 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6683.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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33. Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011;49. https://doi.org/10.1128/JCM.05434-11.
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35. Pal R, Pandey P. Modern Pharmaceutical Analytical Techniques Experiments. Estimation of Sodium (Na) and Potassium (K) Ions by Flame Photometry 2023. https://doi.org/10.13140/RG.2.2.34285.87522.
36. Hsiung CS, Andrade JD, Costa R, Ash KO. Minimizing interferences in the quantitative multielement analysis of trace elements in biological fluids by inductively coupled plasma mass spectrometry. Clin Chem 1997;43. https://doi.org/10.1093/clinchem/43.12.2303.
37. Kaur J, Gupta G, Chane R, Singh MK. Evaluation of serum electrolyte status among newly diagnosed cases of pulmonary tuberculosis: an observational study. International Journal of Health and Clinical Research 2021;4.
38. Chahar AS, Singh MK, Saini VS, Chauhan N, Shaky P. Evaluation of serum electrolyte status among healthy individuals and newly diagnosed cases of pulmonary tuberculosis. J Adv Med Dent Scie Res 2020;8.
39. Soni R, Agrawal R, Sharma S, Suman A. Serum electrolyte disturbances in pulmonary tuberculosis patients before and after antitubercular therapy. Indian Journal of Clinical Biochemistry 2024;39:45–50.
40. Ganiger A, Patil L, Mrudula N. Evaluation of Serum Electrolyte Status among Normal Healthy Individuals and Newly Diagnosed Cases of Pulmonary TB in Tertiary Care Hospital in Bidar: An Observational Study. Indian Journal of Medical Biochemistry 2019;23. https://doi.org/10.5005/jp-journals-10054-0111
2. Glaziou P, Sismanidis C, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Semin Respir Crit Care Med 2018;39:271–85. https://doi.org/10.1055/s-0038-1651492.
3. Dheda K, Barry CE, Maartens G. Tuberculosis. The Lancet 2016;387:1211–26. https://doi.org/10.1016/S0140-6736(15)00151-8.
4. Adrogue HJ, Madias NE. Hyponatremia. New England Journal of Medicine 2000;342:1581–9. https://doi.org/10.1056/NEJM200005253422107.
5. Olalekan AW, Oluwaseun FA, Oladele HA-W, Akeem AD. Evaluation of electrolyte imbalance among tuberculosis patients receiving treatments in Southwestern Nigeria. Alexandria Journal of Medicine 2015;51. https://doi.org/10.1016/j.ajme.2014.10.003
6. Aygün D, Önal P, Klnç AA, Aygün F, Şiraneci R, Çokuğraş H. Can Complete Blood Count Parameters and Serum Electrolyte Levels Have a Predictive Role in Differential Diagnosis of Tuberculosis from Community-acquired Pneumonia in Children? Turkish Archives of Pediatrics 2024;59:289.
7. Reddy P, Mooradian AD. Diagnosis and management of hyponatraemia in hospitalised patients. Int J Clin Pract 2009;63:1494–508. https://doi.org/10.1111/j.1742-1241.2009.02103.x.
8. Patil M. Endocrine and Metabolic Manifestations of Tuberculosis. US Endocrinol 2020;16. https://doi.org/10.17925/USE.2020.16.2.88.
9. Yoshida T, Masuyama H, Yamagata H, Miyabayashi M, Onishi S, Inaba Y, et al. The Incidence and Risk Factors of Hyponatremia in Pulmonary Tuberculosis. J Endocr Soc 2022;6. https://doi.org/10.1210/jendso/bvac130.
10. Jafari NJ, Izadi M, Sarrafzadeh F, Heidari A, Ranjbar R, Saburi A. Hyponatremia due to pulmonary tuberculosis: Review of 200 cases. Nephrourol Mon 2013;5. https://doi.org/10.5812/numonthly.7091.
11. Pliquett RU, Obermuller N. Endocrine testing for the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). 2000.
12. Zaman K, Yunus M, Arifeen SE. Tuberculosis: A global health problem. J Health PopulNutr 2010;28:111–3. https://doi.org/10.3329/jhpn.v28i2.4879.
13. Laville M, Burst V, Peri A, Verbalis JG. Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH): Therapeutic decision-making in real-life cases. Clin Kidney J 2013;6. https://doi.org/10.1093/ckj/sft113.
14. Mayne PD. Clinical Chemistry in Diagnosis and Treatment. 6th ed. Oxford: Oxford Scientific Publications; 1994.
15. Ntambwe M, Maryet M. Tuberculosis and lactic acidosis as causes of death in adult patients from a regional hospital in Johannesburg. Afr J Prim Health Care Fam Med 2012;4. https://doi.org/10.4102/phcfm.v4i1.266.
16. Jacobi J, Prange H, Schwarz A. An unusual case of hyponatraemia. Nephrology Dialysis Transplantation 2010;25:998–1001. https://doi.org/10.1093/ndt/gfp698.
17. Kalaiyarasan K, Ramkumar PP, Mathan K, Sridhar R, Vinodh Kumar G. Electrolyte abnormalities in pulmonary tuberculosis – A retrospective analysis of 86 patients. International Journal of Academic Medicine and Pharmacy 2023;5:722–5. https://doi.org/10.47009/jamp.2023.5.4.144.
18. Nisar A, Lail A, Nisar D, Waheed SA, Saifullah N, Lail G. The Prevalence of Hyponatremia in Pulmonary Tuberculosis Patients, a Tertiary Care Hospital Experience from Pakistan. J Tuberc Res 2019;07. https://doi.org/10.4236/jtr.2019.74026.
19. Dash M, Sen RK, Behera BP, Sahu SS. Prevalence of hyponatremia in pulmonary tuberculosis. International Journal of Advances in Medicine 2019;7. https://doi.org/10.18203/2349-3933.ijam20195638.
20. Upadhyay J, Sudhindra P, Abraham G, Trivedi N. Tuberculosis of the adrenal gland: A case report and review of the literature of infections of the adrenal gland. Int J Endocrinol 2014;2014. https://doi.org/10.1155/2014/876037.
21. Ganiger A, Patil L, Mrudula N. Evaluation of Serum Electrolyte Status among Normal Healthy Individuals and Newly Diagnosed Cases of Pulmonary TB in Tertiary Care Hospital in Bidar: An Observational Study. Indian Journal of Medical Biochemistry 2019;23. https://doi.org/10.5005/jp-journals-10054-0111.
22. D’Attilio L, Santucci N, Bongiovanni B, Bay ML, Bottasso O. Tuberculosis, the disrupted immune-endocrine response and the potential thymic repercussion as a contributing factor to disease physiopathology. Front Endocrinol (Lausanne) 2018;9. https://doi.org/10.3389/fendo.2018.00214.
23. Chung HM, Kluge R, Schrier RW, Anderson RJ. Hyponatremia in untreated active pulmonary tuberculosis. American Review of Respiratory Disease 1969;99:628–32.
24. Vidhale TA, Bhalde RP, Pande M, Mahure SP. Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocyticlymphohistiocytosis (HLH) secondary to pulmonary tuberculosis. BMJ Case Rep 2023;16. https://doi.org/10.1136/bcr-2022-253752.
25. Vorherr H, Massry SG, Fallet R, Kleeman CR. Antidiuretic hormone in tuberculous lung tissue. Ann Intern Med 1970;72:383–7. https://doi.org/10.7326/0003-4819-72-3-383.
26. Verbalis JG, Greenberg A, Burst V, Haymann JP, Johannsson G, Peri A, et al. Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion. American Journal of Medicine 2016;129. https://doi.org/10.1016/j.amjmed.2015.11.005.
27. Ayus M, Moritz H. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Updated 2024 Jan. StatPearls Publishing; 2024.
28. Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocr Rev 2023;44:819–61. https://doi.org/10.1210/endrev/bnad010
29. Al Zaman K, Alhebsi AA, Almheiri A, others. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) in Chronic Respiratory Diseases: A Comprehensive Review. Cureus 2025;17:e77407. https://doi.org/10.7759/cureus.77407.
30. Azadi D, Motallebirad T, Ghaffari K, Shojaei H. Mycobacteriosis and Tuberculosis: Laboratory Diagnosis. Open Microbiol J 2018;12. https://doi.org/10.2174/1874285801812010041.
31. Dunn JJ, Starke JR, Revell PA. Laboratory diagnosis of mycobacterium tuberculosis infection and disease in children. J Clin Microbiol 2016;54. https://doi.org/10.1128/JCM.03043-15.
32. Laifangbam S, Singh HL, Singh NB, Devi KM, Singh NT. A comparative study of fluorescent microscopy with Ziehl-Neelsen staining and culture for the diagnosis of pulmonary tuberculosis. Kathmandu University Medical Journal 2009;7. https://doi.org/10.3126/kumj.v7i3.2728.
33. Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011;49. https://doi.org/10.1128/JCM.05434-11.
34. World Health Organization. WHO Operational Handbook on Tuberculosis: Technical Update on Bacteriologically Confirmed Drug-Resistant Tuberculosis Treatment 2025.
35. Pal R, Pandey P. Modern Pharmaceutical Analytical Techniques Experiments. Estimation of Sodium (Na) and Potassium (K) Ions by Flame Photometry 2023. https://doi.org/10.13140/RG.2.2.34285.87522.
36. Hsiung CS, Andrade JD, Costa R, Ash KO. Minimizing interferences in the quantitative multielement analysis of trace elements in biological fluids by inductively coupled plasma mass spectrometry. Clin Chem 1997;43. https://doi.org/10.1093/clinchem/43.12.2303.
37. Kaur J, Gupta G, Chane R, Singh MK. Evaluation of serum electrolyte status among newly diagnosed cases of pulmonary tuberculosis: an observational study. International Journal of Health and Clinical Research 2021;4.
38. Chahar AS, Singh MK, Saini VS, Chauhan N, Shaky P. Evaluation of serum electrolyte status among healthy individuals and newly diagnosed cases of pulmonary tuberculosis. J Adv Med Dent Scie Res 2020;8.
39. Soni R, Agrawal R, Sharma S, Suman A. Serum electrolyte disturbances in pulmonary tuberculosis patients before and after antitubercular therapy. Indian Journal of Clinical Biochemistry 2024;39:45–50.
40. Ganiger A, Patil L, Mrudula N. Evaluation of Serum Electrolyte Status among Normal Healthy Individuals and Newly Diagnosed Cases of Pulmonary TB in Tertiary Care Hospital in Bidar: An Observational Study. Indian Journal of Medical Biochemistry 2019;23. https://doi.org/10.5005/jp-journals-10054-0111