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Plasma arginine vasopressin and the syndrome of innappropriate antidiuretic hormone secretion in tuberculous meningitis

Biochemical evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was documented in 17 of 24 (71%) children with tuberculous meningitis. Plasma arginine vasopressin concentrations in patients with signs of SIADH were significantly higher (median, 15.44 (range, 1.62 to > 24.52) pg/ml; n=14) than those without (median, 1.91 (range, 0.44 to 4.91) pg/ml; n=6) (P < 0.002). Patients who developed evidence of SIADH were older than those who did not (median, 34 (range, 6 to 101) months us. 10 (range, 6 to 38) months; P < 0.007). Five patients with and none without died. In 9 patients evidence of SIADH developed only after hospitalization. These patients received a median of 58 (range, 28 to 109) ml/kg/day fluids (n=7) before developing evidence of SIADH compared with 107 (range, 58 to 146) ml/kg/day received by patients who did not develop SIADH (n=6) (P=0.035). SIADH occurs commonly and its presence appears to influence the outcome of tuberculous meningitis in children.