Cool Your Jets Bro

History: Twenty-two year old male basic trainee was brought to the ED after collapsing during a routine ruck march. At mile 8/12, soldier was noted to develop an unsteady gate and had witnessed loss of consciousness. A rectal core temperature was obtained and noted to be >107degreeF. Cooling initiated with ice sheets and EMS was activated. On arrival to the ED, patient demonstrated confusion and persistently elevated core temperatures despite ice sheeting, chilled saline and cold water bladder lavage. Cooling measures were discontinued after patient achieved euthermia in the ED;however, his temperatures subsequently spiked>103degreeF. Given rebound hyperthermia, an endovascular cooling (EVC) device was placed in the right femoral vein and patient was transferred to the ICU. Multiple attempts to place EVC device on standby were unsuccessful with subsequent rebound hyperthermia. Prolonged cooling was required. Physical Exam: VS: HR 121, BP 85/68, RR 22 SpO2 100% RA, Temp 102.4degreeF Gen: young adult male, NAD, shivering, A&Ox2 (person and place only) HEENT: Scleral anicteric, conjunctiva non-injected, moist mucus membranes Neck: Supple, no LAD Chest: CTAB, no wheezes/rales/rhonchi CV: tachycardia, regular rhythm, normal S1, S2 without murmurs, rubs, gallops ABD: NABS, soft/non-distended, no guarding or rebound EXT: No LE edema, tenderness SKIN: blisters with broad erythematous bases on bilateral heels Neuro: CN II-XII grossly intact, 5/5 strength in all extremities. Differential Diagnosis: 216. Septic Shock 217. Hypothalamic Stroke 218. Exertional Heat Stroke (EHS) 219. Neuroleptic Malignant Syndrome 220. Thyroid Storm Test Results: CBC: 18.2>14.5/40.6<167 CMP: 128/3.5 88/1831/2.7<104, AST 264, ALT 80, Ca 8.8 Lactate: 7.1 CK: 11 460 Myoglobin: 18 017 TSH: 3.16 CXR: No acute cardiopulmonary process Blood Cx: negative x2 CSF Cx: Negative COVID/Influenza/EBV: Negative Brain MRI: wnl. Final Diagnosis: Exertional Heat Stroke. Discussion(s): No EVC protocols exist for the management of EHS or rebound/refractory hyperthermia. As a result, the protocol used for this patient was adapted from post-cardiac arrest cooling protocols. It is unclear if this adapted protocol contributed to his delayed cooling and rebound hyperthermia as it was not intended for this patient demographic/ pathophysiology. Furthermore, despite initiating empiric antibiotics upon admission, delayed recognition and tailored therapy for his bilateral ankle cellulitis may have contributed to the difficulty in achieving euthermia. In summary, more research needs to be done to evaluate and develop an EVC protocol for EHS. Outcome(s): Euthermia was achieved and maintained after 36 hours of continuous EVC, at which point it was discontinued. His CK, AST/ALT, creatinine and sodium down-trended after discontinuation of EVC. Patient's antibiotics were transitioned to an oral formulation for treatment of ankle cellulitis and he was prepared for discharge. He was discharged with regular follow-up with the Fort Benning Heat Clinic. Follow-Up: After discharge, patient had regularly scheduled visits with the Fort Benning Heat Clinic. His typical lab markers for exertional heat stroke were regularly monitored. He had continued resolution of his Rhabdomyolysis, acute kidney injury and hyponatremia with typical treatment. Soldier returned to duty after 10 weeks of close monitoring and rehabilitation.

Successful matched unrelated donor hematopoietic stem cell transplantation for infantile Wolman disease

Introduction: Wolman disease is a rare genetic disorder with an autosomal recessive inheritance. A mutation in the LIPA gene causes lysosomal acid lipase (LAL) deficiency results in lipid storage and adrenal insufficiency. Death in early infancy is due to liver failure. Patients and methods: We describe the clinical course of a three-month-old infant diagnosed with Wolman disease. A rapid mutational analysis confirmed a LIPA gene defect. Results: He underwent matched unrelated donor peripheral blood stem cell hematopoietic stem cell transplantation (HSCT) at 3 months of age, with a treosulfan-based conditioning, which resulted in engraftment with donor-derived hematopoietic cells. He required supportive care for sinusoidal obstruction syndrome and mucositis. He was administered low dose prednisolone for grade I skin graft versus host disease, and a complete donor chimerism was documented on several occasions. At one year post HSCT, his growth and development were optimal, and there was no hepatosplenomegaly. He is maintained on glucocorticoid and mineralocorticoid supplements for primary hypoaldosteronism. Conclusion: The case emphasizes the timely diagnosis and the potential for successful treatment of Wolman disease by HSCT. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Multisystem inflammatory syndrome in a child with low inflammatory markers, persistent hyponatremia, and natriuresis.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication after infection with Coronavirus disease 2019 (COVID-19), and the differential diagnosis from Kawasaki disease is predominantly based on patients' older age and positive anti-SARS-CoV-2 antibodies in most cases. CASE DESCRIPTION: We report an "atypical" case of MIS-C in a 3.5-year-old child, with relatively low levels of inflammatory markers, persistent hyponatremia, and hypoalbuminemia, along with exceptionally high levels of brain natriuretic peptide (BNP) and myocardial dysfunction. Persistent hyponatremia was mainly related to natriuresis, while BNP elevation was a marker of the disease severity, reflecting abnormal cardiac function. CONCLUSION: Low inflammatory markers in children under the age of five years should not exclude a possible diagnosis of MIS-C. HIPPOKRATIA 2022, 26 (2):83-85.

Severe hyponatremia due to surreptitious water intoxication in a hospitalized patient.

Hyponatremia is a common electrolyte abnormality among hospitalized patients and often present as first sign of other underlying medical conditions. Severe hyponatremia can be life threatening and requires prompt diagnosis and treatment. We present a case of refractory hyponatremia that was a diagnostic challenge requiring a prolonged hospitalization. Diagnosis of primary polydipsia was ultimately suspected due to improbable 24-h urine studies and confirmed through complete removal of free water access in the form of disconnecting the bathroom faucet in the patient's hospital room. Diagnosis and management of primary polydipsia is further discussed.

Cirrhosis and COVID-19: Diffuse venous thrombosis and its clinical implication

A 60-year-old woman with Hepatitis C infection, cirrhosis, recurrent hepatic hydrothorax, and hepatocellular carcinoma was hospitalized with Coronavirus disease-2019 (COVID-19). After her initial discharge, she was re-admitted three weeks later with decompensated liver disease. Imaging revealed extensive thrombosis in the portal vein, superior mesenteric vein, splenic vein and bilateral brachial veins. Given the acute onset and extent of the thrombosis, the patient received therapeutic anticoagulation despite elevated prothrombin time/ international normalized ratio, thrombocytopenia and low fibrinogen. Cirrhotic patients with COVID-19 maybe at high risk of thrombosis, which can present with significant hepatic decompensation.Copyright © 2022 The Author(s)

Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.

Hyponatremia in Empty Sella Syndrome: Is it a Covid Sequelae?

The symptoms associated with empty sella syndrome (ESS) include headache, giddiness, vomiting, visual field deficits, and endocrine problems, as well as the radiological appearance of an enlarged sella turcica. This case report highlights a 45-year-old female who had a COVID-19 infection 2 months back and presented with chronic headache, giddiness, and lethargy having persistent hyponatremia later diagnosed as empty sella syndrome on brain magnetic resonance imaging. In this case, we tried to correlate all of these clinical and radiological features as COVID-19 sequelae due to post-Covid hypothalamic-pituitary axis dysfunction.Copyright © 2023 Authors. All rights reserved.

Dysnatremia in COVID-19 Patients-An Analysis of the COLOS Study.

BACKGROUND: Sodium imbalance is one of the most common electrolyte disturbances encountered in the medical practice, and it may present with either hyponatremia or hypernatremia. Both sodium abnormalities are related with unfavorable outcomes. OBJECTIVE: Elucidation of the prevalence of dysnatremia among COVID-19 patients and its impact on 30- and 90-day mortality and need for ICU admission was the goal. DESIGN AND PARTICIPANTS: A single-center, retrospective, observational study was conducted. A total of 2026 adult, SARS-CoV-2 positive patients, admitted to Wroclaw University Hospital between 02.2020 and 06.2021, were included. On admission, patients were divided into groups: normonatremic (N), hyponatremic (L), and hypernatremic (H). Acquired data was processed, and Cox hazards regression and logistic regression were implemented. KEY RESULTS: Hyponatremia on admission occurred in 17.47% (n = 354) of patients and hypernatremia occurred in 5.03% (n = 102). Dysnatremic patients presented with more comorbidities, used more drugs, and were statistically more often admitted to the ICU. Level of consciousness was the strongest predictor of ICU admission (OR = 1.21, CI: 1.16-1.27, p < 0.001). Thirty-day mortality was significantly higher in both the L and H groups (28.52%, p = 0.0001 and 47.95%, p < 0.0001, respectively), in comparison to 17.67% in the N group. Ninety-day mortality showed a similar trend in all study groups: 34.37% in the L group (p = 0.0001), 60.27% (p < 0.0001) in the H group, and 23.32% in the N group. In multivariable analyses, hypo- and hypernatremia were found to be independent predictors of 30- and 90-day mortality. CONCLUSIONS: Both hypo- and hypernatremia are strong predictors of mortality and disease severity in COVID-19 patients. Extraordinary care should be taken when dealing with hypernatremic, COVID-positive patients, as this group exhibits the highest mortality rates.

Incidence of Hyponatremia Among Critically Ill Patients With and Without COVID-19 Infection at a Community Teaching Hospital.

Background: Various studies have demonstrated the incidence of hyponatremia in patients with Coronavirus Disease 2019 (COVID-19); however, to our knowledge, no study has assessed the difference in the incidence of hyponatremia in patients with and without COVID-19. Purpose: To compare the incidence of hyponatremia in patients requiring intensive care unit (ICU) admission with and without COVID-19 infection. Methods: This was a single-center, retrospective cohort study of patients with a diagnosis of pneumonia from February 2019 to January 2020, or a diagnosis of COVID-19 from June 2020 to May 2021. Included patients were matched on age and sex. The primary outcome was the incidence of hyponatremia within 72 h of admission. Secondary endpoints collected included severity of hyponatremia, symptomatic hyponatremia, and lowest serum sodium. Results: There were 99 and 104 patients included in pneumonia and COVID-19 arms, respectively. Twenty-nine patients in the pneumonia group and 56 patients in the COVID-19 group had a sodium level <134 mEq/L (29% vs 56%, RR 1.84, P < .01). The mean lowest serum sodium within 72 h of admission was 136.9 mEq/L in the pneumonia group and 134.5 mEq/L in the COVID-19 group (P < .01). Other notable findings included days of mechanical ventilation (3 days vs 8 days, respectively; P < .01), downgrade from the ICU (74.8% vs 59.6%, P = .02), ICU length of stay (4 days vs 10 days, P < .01), hospital length of stay (6 days vs 14 days, P < .01), and mortality (16.2% vs 39.4%, P < .01). Conclusion: Among critically ill patients with COVID-19, the risk of hyponatremia was significantly greater than the risk in critically ill patients with pneumonia.

Comparative Study of Serum Electrolytes in Covid-19 and Healthy Patients in Tertiary Care Center, Karimnagar

Introduction- Electrolyte balance of the body is maintained by renin angiotensin aldosterone system. Some previous studies suggested that COVID-19 is associated with gastrointestinal symptoms, such as diarrhea and vomiting. This may results in electrolyte disturbances in patients. Electrolytes in body like sodium (Na), potassium (K). Chloride (Cl) plays an important physiological role in maintaining acid base and water balance of cells of the body. Aims and objectives: Our study aimed to compare some electrolyte between covid 19 and non-covid patients retrospectively. Material(s) and Method(s): This retrospective study included total 57 males and 43 females in the age group of 28 to 65 years. The results were compared with 100 age and sex matched healthy controls. Estimation of serum electrolytes was done with the collected venous blood samples using the ion selective electrode technique in an electrolyte analyzer. Analysis was done using SPSS V 25 Software. Chi-square and t-test were used to see association and difference between two variable respectively. Result(s): We have found that covid 19 is associated with low levels of electrolytes like Na, K, Cl. Chloride levels in both the groups was not statistically significant. But Hyponatremia and Hypokalemia were observed in cases group with high statical Signficance. Conclusion(s): Study found that electrolytes deterioration in these patients play a critical role in patients management. Thus a monitoring of electrolyte is essential throughout their illness to manage covid patients to improve their quality of life.Copyright © 2020 Ubiquity Press. All rights reserved.

The Relationship of Hyponatremia with Il-6 and Implications on Clinical Outcomes in Covid-19 Patients Admitted at University Santo Tomas Hospital, January to August 2021

Introduction: COVID-19 is a droplet-transmitted infection with clinical manifestation ranging from mild disease to cytokine storm. The cytokine storm is an exaggerated response of the human body in which excessive amounts of inflammatory markers are released leading to multiple organ failure. In COVID-19, the most common electrolyte disorder noted is hyponatremia. Hyponatremia results from an increase in cytokines including IL-6 can result in the release of anti-diuretic hormone causing a decrease in serum sodium. Hyponatremic patients were observed to have increased risk for ICU admission, mechanical ventilation and mortality as compared to normonatremia. The inflammatory markers including serum ferritin, procalcitonin, IL-6, HsCRP, LDH, and D-dimer have been imperative as prognostic markers to help guide healthcare workers in the classification of severity, thereby guiding management. This study aims to investigate the association between serum sodium and serum IL-6 and aims to establish the role of serum sodium as an alternative cost-effective prognostic marker for COVID-19. Method(s): This is a retrospective cohort study done at the University of Santo Tomas Hospital via chart review of all confirmed COVID-19 patients admitted from January to August 2021. Data gathered included patient's age, gender, pertinent co-morbidities, day of illness on arrival, serum Na, PF ratio, chest radiograph, IL-6 levels on admission. The outcome of each case was recorded: oxygen supplementation, need for hemoperfusion, need for tocilizumab, COVID classification, days until clinical recovery, discharged, or expired. Corrected serum was used to account for effect of serum glucose on serum sodium. Serum sodium and IL-6 levels were compared to check the relationship between the two. Hyponatremia was studied in line with the poor outcomes. COVID-19 patients admitted at the COVID ward of USTH, January to August 2021 was the target population of the study. Those excluded were patients with chronic kidney disease patients, chronic hyponatremia, malignancy, uncontrolled thyroid disease, liver cirrhosis, on diuretics, with gastrointestinal losses and incomplete records. [Formula presented] Results: Of the 322 admitted COVID-19 patients, 154 were included with 89 (58%) having poor outcomes. Hyponatremia was seen in 60 (38.9%) of the population while 48 (53.93%) had poor outcomes. Serum sodium and IL-6 have an inverse relationship is not statistically significant. Patients with hyponatremia were 4.46 times more likely to require high oxygen support, 4.16 times more likely to need hemoperfusion, and 60.71% times more likely to have ICU admission. Hyponatremia was shown to have a 94.12% likelihood need for tocilizumab, 3.87 times more likely to result in severe or critical COVID-19 and 3.78 times more likely to expire. Overall, hyponatremia was 5.17 times more likely to have poor clinical outcome in comparison to normonatremia. Conclusion(s): Serum sodium cannot replace serum IL-6 as an inflammatory marker, but could be considered as a potential prognostic marker for COVID-19 when inflammatory markers are not available. COVID-19 patients with hyponatremia have a higher predisposition to increased disease severity. Including serum sodium in scoring systems could help signal to the health care providers that a more aggressive treatment approach would be indicated, thus aiding physicians in managing patients more effectively. No conflict of interestCopyright © 2023

Serum Sodium as a Predictor of Morbidity and Mortality in Covid-19 Patients Admitted to the University Hospital of the West Indies between August 2020-January 2021

Introduction: Dysnatremia is common in patients with acute coronavirus disease 2019 (COVID-19). Robust studies looking at the association between sodium imbalance in patients with COVID-19 and clinical outcome remain lacking.This study aimed to identify the prevalence of dysnatremia among patients hospitalized with acute COVID-19 infection. It also sought to determine the association between serum sodium and both mortality and morbidity, as measured by the severity of COVID-19 infection, the need for ventilatory support, intensive care unit (ICU) admission and acute kidney injury (AKI). We sought to evaluate whether sodium levels, a relatively inexpensive and easily accessible lab investigation, may be employed as a predictor of outcome in patients admitted with COVID-19 infection. Method(s): This was a retrospective cohort studyconducted from an electronic medical records review of all hospitalized, adult patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) at the University Hospital of the West Indies between August 1, 2020, and January 31, 2021. The relationship between dysnatremia (serum sodium <135 mmol/l or >145 mmol/l) and in-hospital mortality and morbidity were examined. A total of 374 COVID-19 patients were enrolled. The study was approved by the Mona Campus Research Ethics Committee, an independent body which is housed in the Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Result(s): The incidence of hyponatremia and hypernatremia were 29.4% and 6.1% respectively. The mean admission serum sodium was 137.3 +/- 6.0 mmol/l. At the end of the study period, the prevalence of hyponatremia and hypernatremia was 50.3% and 19.8% respectively. Acute kidney injury occurred in 117 patients (31.3%) with 23 patients (6.1%) having an unknown status due to missing data. Hypernatremia was associated with a higher prevalence of AKI (60.9%) than hyponatremia (35.5%) (chi2=13.8, p=0.008). Serum sodium at presentation was higher among the non-survivors (139.3 +/- 7.2 mmol/l), compared to the survivors (136.7 +/- 5.5 mmol/l) (p<0.001). Patients with hypernatremia had a survival rate of 52.2% at a survival average of 18.3 days, significantly lower than patients with hyponatremia (80.9%) or normonatremia (77.6%) (p=0.001). There was statistically significant association between the presence of hypernatremia and in-patient mortality (chi2=9.0, p=0.011) but there was no association with hyponatremia. The majority of the patients (56.1%) had severe COVID-19 infection. Non-severe and critically ill patients accounted for 32.1% and 11.8% respectively.Comparison of serum sodium at presentation to the severity of COVID-19 infection did not show statistical significance(chi2=1.7, p=0.794). There was no statistically significant difference between serum sodium levels and oxygen therapy (chi2=1.4, p=0.502) or the use of mechanical ventilatory support (chi2=4.6, p=0.798). There was no statistical significance in the length of hospital stay across sodium groups (p=0.179). Conclusion(s): Hypernatremia was associated with both a higher risk of acute kidney injury and in-hospital mortality, but not morbidity. Hyponatremia either on admission or developed during the hospitalization was not associated with poor clinical outcomes. Serum sodium can be used in the prognostication and risk stratification of patients with acute COVID-19 infection. No conflict of interestCopyright © 2023

Liposomal amphotericin associated nephrotoxicity in patients with Mucormycosis: An epidemic in the midst of Pandemic

Introduction: Following second wave of COVID 19 infection in India there has been unprecedented spike in mucormycosis cases. Liposomal amphotericin(LAmB) is the drug of choice in most of these cases. Though nephrotoxicity of conventional amphotericin has been well described in literature, there is sparse data on nephrotoxicity following of LAmB use.Herein we describe spectrum of kidney disease and electrolyte abnormalities that arised following LAmB use in patients afflicted with mucormycosis. Method(s): It is a single centre retrospective observational study. Hospitalised patients with mucormycosis who were started on LamB and if they develop Acute Kidney Injury (AKI)criteria as per KDIGO2012 guidelines during hospital stay were included in the study after excluding patients with pre existing Chronic Kidney Diseases( CKD),concomitant use of other Nephrotoxic medications,use of nonLAmB formulations for mucormycosis treatment,AKI at the time of admission and critical illness requiring ICU stay.Their demographic characteristics,co morbidities,salient clinical examination findings and laboratory parameters were entered in excel sheet.Descriptive statistics were used to analyse data. Result(s): Mean Age of study population was 51.03 years. Male to female ratio was 25:6.Among comorbidities, Diabetes was seen in 74.19% cases, Hypertension was seen in 35.4% and Ischemic Heart disease was seen 9.6% cases. When risk factors for mucormycosis were analysed 100% of study population had recent COVID19 infection, 93.5% of study population had prior steroid use and 9.6% of the patients had received Tocilizumab. Out of 102 patients who received LAmB 31(30.3%) developed AKI. Among these cases, Stage1 AKI was seen in 8 (25.8 %) cases,Stage 2 AKI was seen in 17 (54.8%) cases and Stage3 AKI was seen in 6 (19.3%) cases. None of these patients had oliguria or requirement of dialysis during hospital stay. 54.8% of patients had persistent AKI at the time of discharge.Hypokalemia was seen in 77.4% cases and 41.9% had severe hypokalemia requiring IV potassium treatment.Hyponatremia was seen in 51.6% cases, most of these cases were mild and only one patient had severe hyponatremia requiring hypertonic saline infusion.Hypomagnesemia was seen in 29 % cases. Conclusion(s): LAmB was associated with significant nephrotoxicity resulting in development of AKI in 30% of cases.Most of these cases had stage 2 AKI and none of them required dialysis support.Almost half of the study population had persistent AKI at the time of discharge.Among the electrolyte disorders,Hypokalemia was particularly severe. No conflict of interestCopyright © 2023

The Frequency of Dysnatremia in Patients Admitted with Covid-19 Infection

Introduction: Numerous studies have shown both hyponatremia and hypernatremia to be independently associated with mortality. Patients infected with Covid-19 infection can develop severe life threatening pneumonia and the mortality in these patients can be as high as 20.3% to 27.9%. While respiratory tract involvement is one of the main manifestation of Covid -19 infection, many patients also have associated dysnatremias. The reported prevalence of hyponatremia and hypernatremia in Covid -19 patients has been 25%-45% and 3% to 7% respectively. Recently, it has also been observed that patients with covid-19 infection develop severe treatment resistant hypernatremia > 150 mEq/L, which is difficult to correct. In patients with Covid-19 infection, dysnatremia is a frequent occurrence, although its relationship with mortality needs to be established. We aimed to study the frequency of dysnatremia in patients with Covid -19 infection at different stages of admission. Method(s): This retrospective analysis was conducted at Aga Khan University Hospital, Karachi, Pakistan over a period of twelve weeks. All admitted adult patients with covid -19 were included. Three levels of serum sodium were recorded: on admission, maximum level anytime during hospital stay and at the time of discharge or death (+/- 48 hours). Based on the serum level of sodium, three definitions were used: hyponatremia, hypernatremia and normonatremia. Hypernatremia was further categorized into mild, moderate and severe. Patients developing acute kidney injury (AKI) was also recorded. The main outcome measure was inpatient mortality. Result(s): The study included 574 patients;median age was 55.6 +/-14.4 years. On admission, the mean sodium was 135.9 +/- 6.4 mEq/L, 39% patients had hyponatremia and 4.7% had hypernatremia. During hospital admission, the percentage of hypernatremia increased to 18.8%: 12.7% had mild, 4.5% had moderate and 1.6% had severe hypernatremia. The mean serum sodium, during hospital stay, in patients who survived was around 140.6 +/- 5 as compared to 151 +/- 9.9 mEq/L in those who died with p value <0.001. The last mean serum sodium checked before death or discharge (+/- 48 hours) was 145.4 +/- 9.4 mEq/L as opposed to 137.7 +/- 3.7 mEq/L with p value of <0.001 in patients who died and survived respectively. The mean serum creatinine on admission was 1.3 +/-1.3 mg/dl;200 (34.8%) patients developed AKI;100 (50%) patients developed stage 1 AKI, 49 (24.5%) had stage 2 and 50 (25%) had stage 3 AKI. Around 36 (6.3%) required renal replacement therapy. The predictors of AKI included severity of Covid-19 [p = 0.001], age [p = <0.001], hypertension [p = 0.04] and invasive ventilation [p = 0.01]. Overall, mortality was 10.97%. Conclusion(s): Hyponatremia on admission is commonly seen in patients admitted with Covid -19 infection, whereas hypernatremia is a frequent finding in patients who could not survive, however their association with mortality needs to be established. No conflict of interestCopyright © 2023

Prevalence of hyponatremia in hospitalized patients with coronavirus disease 2019, a multicenter study

Introduction: In patients with coronavirus disease 2019 (COVID-19), the prevalence of hyponatremia has been reported with varying outcomes. Objective(s): The aim of this study was to evaluate the prevalence of hyponatremia in hospitalized patients with COVID-19. Patients and Methods: In this multicenter cross-sectional study, information about hospitalized patients with COVID-19 admitted between March 2020 and September 2020, including age, gender, and serum levels of sodium, creatinine, and potassium, as well as blood urea nitrogen (BUN), was analyzed, while P value level less than 0.05 was considered significant. Result(s): A total of 667 hospitalized patients with COVID-19 were enrolled in the study, of which 54.4% were male. The median age of patients was 63 years old. About 39.4% of patients had hyponatremia on admission day. More than 80% of patients had mild hyponatremia. The median age of the hyponatremia group was significantly higher than that of eunatremia group. Conclusion(s): Our data showed that hyponatremia is observed in hospitalized patients with COVID-19 and is often mild.Copyright © 2023 The Author(s);Published by Society of Diabetic Nephropathy Prevention.

Complete Heart Block: A Case Report and Review of a Rare Manifestation of COVID-19

Covid19 is still one of the major public health problems of all countries nowadays. The most common cardiac manifestations reported till now are acute coronary syndrome, myocarditis, and arrhythmia. The prevalence of COVID-19 induced arrhythmias is different in recent reports and varies from benign sinus tachycardia to more ominous cases of severe bradycardia or even malignant ventricular arrhythmias. Here in, we describe a case of complete heart block in severe covid-19 pneumonia and review all recent relevant case reports published to date in order to understand the probable mechanisms and contributing factors of this rare complication of the disease.Copyright © 2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.

Association of Dysnatremia with Morbidity and Mortality of Covid-19 Patients Admitted in the Intensive Care Units of a Tertiary Care Hospital: A Retrospective Cohort Study

Introduction: The coronavirus disease 2019 (COVID-19) has rapidly spread globally and infected millions, with increasing infection rates and mortality. In our institution, there have been several cases of COVID-19 patients who, in the initial laboratory exam at the ED (Emergency Department), turned out to be dysnatremic. On admission, most patients with normal serum Na+ developed dysnatremia during their ICU (Intensive Care Unit) stay. This study aimed to determine the relationship between serum Na+ levels on presentation and any point during hospitalization with morbidity and mortality in critically ill COVID-19 subjects. Method(s): This retrospective cohort study included 261 patients aged 18 years and above diagnosed with COVID-19 infection confirmed by positive real-time RT PCR test, who were admitted from January 2020 to December 2021 in the critical care units of a tertiary care hospital. The outcomes were evaluated after 8 weeks of hospitalization as to AKI (Acute Kidney Injury), length of hospital stay, length of ICU stay, need for ventilator support, vasopressor support, COVID recovery, and mortality. Subjects' serum Na+ levels were obtained on admission, day 3, day 7, day 14, and the last serum Na+ before death or discharge. Result(s): Among the 261 COVID-19 cases analyzed, the number of patients with either hyponatremia or hypernatremia on presentation and anytime during hospitalization was 67.05%. The predominant disorder was hyponatremia, seen in 51.34% of patients (95% CI 45.10% to 57.55%). Hypernatremia was seen in 36 patients, or 13.79%. The most common etiology of both disorders was hypovolemia, mostly from poor oral intake, followed by insensible losses from fever and tachypnea, and GI losses. Mortality rates were higher in hypovolemic patients compared to euvolemic patients (86.21% vs. 42.86% in hypernatremic patients;62.77% vs. 53.85% in hyponatremic patients). Patients with dysnatremia had a significantly higher proportion of AKI (80% vs. 31.4%, p < 0.001), a longer length of ICU stay (19 vs. 12 days, p < 0.001), a higher proportion that required ventilator support (80% vs. 28%, p < 0.001) or vasopressor support (73.71% vs. 20.93%, p < 0.001), and death (64% vs. 2.33%, p < 0.001) after 8 weeks of hospitalization. In a subgroup analysis of hypernatremic and hyponatremic patients, it appeared that hypernatremia had worse outcomes in terms of AKI (94.44% vs. 75.37%), length of ICU stay (IQR 16-35 vs. 14-25), need for ventilator support (91.67% vs. 77.61%), vasopressor support (86.11% vs. 70.9%), and death (77.78% vs. 60.45%). [Formula presented] Conclusion(s): Dysnatremia at any time point during the ICU stay is related to excess mortality. Hypernatremia was a significant risk factor for mortality, especially for the subgroup of hypovolemic patients. Dysnatremia was found to be more frequent on the day of presentation in the ED, making it a potential risk stratification tool for determining COVID-19 severity and poor outcomes. Clinicians managing COVID-19 patients should know that dysnatremia anytime during hospitalization confers a higher risk for death than those presenting with normal Na+ levels, and early nephrology referral may provide benefit. No conflict of interestCopyright © 2023

Assessment and management of the SARS-CoV-2 infection: A secondary center experience: Approach to COVID-19 infection

Aim: The aim of the study was to evaluate the management and outcomes of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a secondary hospital. Material(s) and Method(s): This study included 699 hospitalized patients who had positive rRT-PCR for SARS-CoV-2 and/or typical findings of COVID-19 on chest computed tomography (CT). Demographics, comorbidities, initial laboratory tests on admission, treatment modalities, complications and outcomes were evaluated retrospectively. Result(s): The mean age was 57.0+/-15.6 (range:16-94 years), and male to female ratio was 1.24;58.7% of the patients had at least one underlying comorbidity, the most common was hypertension;18.1% of the patients had lymphopenia, 35.7% hyperferritinemia, 58.3% had increased lactate dehydrogenase, and 58.5% had increased D-dimer. Chest CT revealed moderate and severe stages in 57.9% of the patients. Hydroxychloroquine was given to 37.2% and favipiravir to 67.1% of the patients. No significant difference was observed between treatment groups in terms of mortality (P=0.487);5.8% of the patients were transferred to the ICU, 75.6% of whom needed non-invasive and 36.5% invasive mechanical ventilation. The overall case-fatality rate was 0.9. Discussion(s): Older age, male gender, low lymphocyte count, CT findings, including bilateral involvement and severe stage were significantly associated with poor prognosis and mortality.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Urinary Retention and Severe Hyponatremia: An Unusual Presentation of COVID-19.

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019. The disease is caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). A few published cases have linked COVID-19 and hyponatremia. The mechanism of hyponatremia in these cases is related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Here we present a unique case of urinary retention and SIADH as unusual presenting features of SARS-CoV-2 infection. LEARNING POINTS: Urine retention could be an unusual presenting symptom of severe hyponatremia of COVID-19.Hyponatremia and SIADH could be unusual presenting features of SARS-CoV-2 infection.Careful correction of hyponatremia related to COVID-19 is necessary to avoid osmotic demyelination syndrome.