Clinical profile of patients with hyponatremia in a tertiary care hospital in the sub-Himalayan region.

INTRODUCTION: Hyponatremia, defined as a serum sodium concentration ([Na+]) <135 mEq/L. It is not a disease but rather a pathophysiologic process indicating disturbed water homeostasis. Hyponatremia should be further classified to provide directions for diagnosis and treatment. It is a heterogeneous disorder. The classifications of hyponatremia are commonly based on tonicity and volume status. The initial differentiation in hypotonic and non-hypotonic hyponatremia is important because management is different. Several studies have been conducted previously to measure the incidence of hyponatremia in medically ill patients. Several studies have demonstrated an increased prevalence of hyponatremia in the presence of co-morbid conditions. We conducted this study to bring out various causes of hyponatremia; their relation with sex, age and outcome and hyponatremia's classification and incidence in our hospitalised population. MATERIALS AND METHODS: This study was conducted to find out etiology, classification, prevalence and outcome and its relation with age and sex in patients of hyponatremia admitted in our institution. A total number of 106 patients were studied. RESULTS: Hospital-based incidence of hyponatremia was found to be 1.17%. Mean age of patients in study was 62.25 ± 17.7 years. Male to female ratio was 1.25:1. Altered sensorium was the most common neurological symptom. Ninety-five (90%) patients were hypo-osmolar. Out of ninety four patients, 38 (40%) were euvolemic. Chronic obstructive pulmonary disorder (COPD) with cor pulmonale with right-sided heart failure (n = 9, 31%) was the most common cause in hyper-volemic hyponatremia. Acute gastroenteritis (n = 13, 48%) was the most common cause in hypo-volemic hyponatremia. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was the most common cause (n = 20, 53%) of euvolemic hyponatremia. Out of 106 patients, 11 (10.38%) patients expired. CONCLUSION: Hyponatremia acts as a poor prognostic marker of the primary disease. It is important to recognise it early because of the potential morbidity and mortality, economic impact on the patients and health care associated with it. Early management of hyponatremia, which includes determination of the rate of correction, the appropriate interventions and the presence of other underlying disorders, may help in improving the outcome and shortening the hospital stay of the patients.

Scrub Meningitis Complicated by Multiple Cranial Nerve Palsies and Cerebellitis.

Meningitis or meningoencephalitis is a known complication of scrub typhus. Focal neurological deficits are rarely reported including hemiparesis, quadriparesis and isolated cranial nerve palsies. Here we are reporting a 24 years female who presented with fever, headache, ptosis, diplopia, facial deviation and unsteadiness of gait due to scrub typhus. Scrub typhus can present as acute or subacute meningitis complicated by multiple cranial palsies and cerebellitis. Hence it needs to be differentiated from acute bacterial meningitis and tubercular meningitis as delay in diagnosis and treatment will affect the morbidity and mortality.

Hypertension as Determinant of Hyperuricemia: A Case Control Study from the Sub-Himalayan Region in North India.

Background: Association between hyperuricemia and hypertension has been recognized for many years. Whether hyperuricemia is the cause or the effect is debatable. Materials and methods: This case control study was conducted to assess serum uric acid (SUA) levels in fifty newly diagnosed essential hypertensive patients and fifty normotensive controls which were matched for age and sex. Detailed anthropometric characteristics including height, weight, body mass index and waist hip ratio were measured. Hypertension was classified according to Joint National Committee (JNC) 7 criteria. Hyperuricemia was defined as SUA level of 6.8mg/dl or more in both men and women. SUA was measured by uricase method. Before collecting the blood samples, patients were advised to proceed on overnight fast of minimum eight hrs. Student's t­test for mean of continuous variables and Chi­square test for proportions were used for statistical significance. Results: Present study included 50 newly diagnosed cases of essential hypertension and 50 age and sex matched normotensive healthy volunteer. Prevalence of hyperuricemia was 24% among the cases and 6% among the controls (P < 0 .05). Odds ratio was 4.9 (Cl=1.3 to 18.8). The mean SUA was significantly higher in the cases (5.5±1.7 mg/dl) than in the controls (4.9±1.1 mg/dl; P< 0.05). Odds ratio in male hyperuricemic hypertensive versus hyperuricemic normotensive was 6(CI=1.0 to 33.2) and 4.46(CI=0.4 to 42.5) among female hyperuricemic hypertensive versus hyperuricemic normotensives. Conclusion: Strong positive association was observed between hypertension and hyperuricemia in both male and female patients in this study.