Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
1.
Acta Biomed ; 92(5): e2021474, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1504914

ABSTRACT

Hyponatraemia is frequently encountered in adults with coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. This review aims to describe for the first time the prevalence, aetiology, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19, taking into account all relevant studies published in PubMed and Cochrane Library studies until 26th September 2021. Literature search did not detect any studies evaluating the prevalence and prognostic value of sodium disorders in paediatric patients with COVID-19. A broader literature review showed a high prevalence of hyponatraemia in children with bacterial pneumonia, while some studies have reported that hyponatraemia is relatively common in Multisystem Inflammatory Syndrome in Children (MIS-C). In adults with COVID-19, an inverse association between sodium and interleukin-6 levels has been found, indicating that hyponatraemia could be used as a surrogate marker for the risk of cytokine storm and may facilitate the identification of patients who could benefit from immunomodulatory agents. Studies are urgently needed to evaluate the frequency and prognostic impact of electrolyte abnormalities in children with COVID-19. In the meantime, clinicians are urged to consider hyponatraemia in children with COVID-19 as a potential red flag, investigate the cause and administer fluids and other therapies accordingly.


Subject(s)
COVID-19 , Hyponatremia , Adolescent , Adult , COVID-19/complications , Child , Humans , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/therapy , Prevalence , Prognosis , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
2.
Eur J Endocrinol ; 185(4): G35-G42, 2021 Aug 27.
Article in English | MEDLINE | ID: covidwho-1448609

ABSTRACT

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20-30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3-5%, especially in ICU, and derives from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Subject(s)
COVID-19/epidemiology , Diabetes Insipidus/therapy , Endocrinology/standards , Hyponatremia/therapy , Ambulatory Care/methods , Ambulatory Care/standards , Consensus , Diabetes Insipidus/epidemiology , Diabetes Insipidus/pathology , Distance Counseling/methods , Distance Counseling/standards , Endocrinology/history , Endocrinology/trends , Expert Testimony , History, 21st Century , Hospitalization/statistics & numerical data , Humans , Hyponatremia/epidemiology , Hyponatremia/pathology , Pandemics , Practice Patterns, Physicians'/history , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/trends , SARS-CoV-2 , Severity of Illness Index , Telemedicine/history , Telemedicine/methods , Telemedicine/standards
3.
Eur J Endocrinol ; 185(4): R103-R111, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1348376

ABSTRACT

This review examines the prevalence, aetiology, pathophysiology, prognostic value, and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20-35% prevalence for hyponatraemia and 2-5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio (OR) of 1.83-3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an OR of 1.40-1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role in risk stratification and individualising therapy.


Subject(s)
COVID-19 , Hypernatremia , Hyponatremia , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Hospitalization/statistics & numerical data , Humans , Hypernatremia/diagnosis , Hypernatremia/epidemiology , Hypernatremia/etiology , Hypernatremia/therapy , Hyponatremia/diagnosis , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/therapy , Pandemics , Predictive Value of Tests , Prevalence , Prognosis , Risk Factors , Severity of Illness Index
5.
J Neurovirol ; 26(5): 797-799, 2020 10.
Article in English | MEDLINE | ID: covidwho-1070964

ABSTRACT

There is concern that the global burden of coronavirus disease of 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection might yield an increased occurrence of Guillain-Barré syndrome (GBS). It is currently unknown whether concomitant SARS-CoV-2 infection and GBS are pathophysiologically related, what biomarkers are useful for diagnosis, and what is the optimal treatment given the medical comorbidities, complications, and simultaneous infection. We report a patient who developed severe GBS following SARS-CoV-2 infection at the peak of the initial COVID-19 surge (April 2020) in New York City and discuss diagnostic and management issues and complications that may warrant special consideration in similar patients.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Guillain-Barre Syndrome/complications , Hyponatremia/complications , Pneumonia, Viral/complications , Acute Disease , Aged , Anticoagulants/therapeutic use , COVID-19 , Coronavirus Infections/pathology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Disease Progression , Enoxaparin/therapeutic use , Female , Guillain-Barre Syndrome/pathology , Guillain-Barre Syndrome/therapy , Guillain-Barre Syndrome/virology , Humans , Hyponatremia/pathology , Hyponatremia/therapy , Hyponatremia/virology , New York City , Pandemics , Plasmapheresis , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , SARS-CoV-2
6.
Rev Endocr Metab Disord ; 22(2): 317-324, 2021 06.
Article in English | MEDLINE | ID: covidwho-1064568

ABSTRACT

SARS-COV2 infection has swiftly become a pandemic disease of historic relevance and widely variable outcomes. This variable prognosis is related both to uneven damage, among others, to lungs, heart and kidneys, and to a multisystemic inflammatory reaction. All these factors are known to disrupt water balance and potentially induce hyponatraemia or hypernatraemia. Water balance disorders are known mortality and morbidity risk factors in several clinical scenarios and their proper management, though often complex and hazardous, can reduce mortality and length of hospitalization. Clinical uncertainty over COVID-19 outcome, the variety of organs involved in both the infection and water balance and difficulties in clinical examination due to risk of contagion might obstruct proper management of dysnatremic disorders. Thus, the Acqua Neuroendocrinology Group of the Spanish Society for Endocrinology (SEEN) has endeavoured to provide evidence and expert based recommendations on the management of hyponatraemia and hypernatraemia in COVID-19 patients.


Subject(s)
COVID-19/therapy , Consensus , Hypernatremia/therapy , Hyponatremia/therapy , Neuroendocrinology/standards , Practice Guidelines as Topic/standards , Societies, Medical/standards , COVID-19/complications , Humans , Hypernatremia/etiology , Hyponatremia/etiology , Spain
7.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066835

ABSTRACT

SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host's cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.


Subject(s)
Adrenal Insufficiency/physiopathology , COVID-19/physiopathology , Hyponatremia/physiopathology , Hypotension/physiopathology , Acidosis/blood , Acidosis/physiopathology , Acidosis/therapy , Adrenal Insufficiency/blood , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , COVID-19/blood , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrocortisone/blood , Hyponatremia/blood , Hyponatremia/therapy , Hypophosphatemia/blood , Hypophosphatemia/physiopathology , Hypophosphatemia/therapy , Hypotension/therapy , Male , Middle Aged , Pituitary-Adrenal Function Tests , Prednisolone/therapeutic use , SARS-CoV-2 , Vomiting/physiopathology , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapy
8.
Ann Neurol ; 89(3): 610-616, 2021 03.
Article in English | MEDLINE | ID: covidwho-1044305

ABSTRACT

There is emerging evidence for multifarious neurological manifestations of coronavirus disease 2019 (COVID-19), but little is known regarding whether they reflect structural damage to the nervous system. Serum neurofilament light chain (sNfL) is a specific biomarker of neuronal injury. We measured sNfL concentrations of 29 critically ill COVID-19 patients, 10 critically ill non-COVID-19 patients, and 259 healthy controls. After adjusting for neurological comorbidities and age, sNfL concentrations were higher in patients with COVID-19 versus both comparator groups. Higher sNfL levels were associated with unfavorable short-term outcome, indicating that neuronal injury is common and pronounced in critically ill patients. ANN NEUROL 2021;89:610-616.


Subject(s)
COVID-19/blood , Neurofilament Proteins/blood , Adult , Aged , Aged, 80 and over , COVID-19/physiopathology , COVID-19/therapy , Case-Control Studies , Critical Illness , Female , Glasgow Outcome Scale , Hospital Mortality , Humans , Hyponatremia/blood , Hyponatremia/therapy , Intensive Care Units , Length of Stay/statistics & numerical data , Male , Middle Aged , Organ Dysfunction Scores , Pulmonary Edema/blood , Pulmonary Edema/therapy , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/blood , Respiratory Insufficiency/therapy , Respiratory Tract Infections/blood , Respiratory Tract Infections/therapy , SARS-CoV-2 , Shock, Cardiogenic/blood , Shock, Cardiogenic/therapy
9.
Eur J Endocrinol ; 184(3): 409-418, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1034947

ABSTRACT

Objective: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. Conclusion: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Hypernatremia/diagnosis , Hypernatremia/epidemiology , Hyponatremia/diagnosis , Hyponatremia/epidemiology , Adult , Aged , COVID-19/complications , COVID-19/therapy , Case-Control Studies , Cohort Studies , Critical Care/statistics & numerical data , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Hypernatremia/complications , Hypernatremia/therapy , Hyponatremia/complications , Hyponatremia/therapy , Length of Stay/statistics & numerical data , Male , Middle Aged , Mortality , Pandemics , Prevalence , Prognosis , Prospective Studies , SARS-CoV-2 , Switzerland/epidemiology , Triage
10.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Article in English | MEDLINE | ID: covidwho-1016197

ABSTRACT

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, and the absence of specific therapeutic methods. COVID-19 can manifest with non-specific symptoms and signs, especially among the elderly. In some cases, the clinical manifestations of hyponatremia may be the first to appear. The pathophysiological mechanisms of hyponatremia among patients with COVID-19 are diverse, including syndrome of inappropriate antidiuretic hormone secretion (SIADH), digestive loss of sodium ions, reduced sodium ion intake or use of diuretic therapy. Hyponatremia may also be considered a negative prognostic factor in patients diagnosed with COVID-19. We need further studies to evaluate the etiology and therapeutic management of hyponatremia in patients with COVID-19.


Subject(s)
COVID-19/metabolism , Hyponatremia/metabolism , Inappropriate ADH Syndrome/metabolism , COVID-19/complications , Diuretics/adverse effects , Fluid Therapy/methods , Humans , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/therapy , Inappropriate ADH Syndrome/etiology , Incidence , Interleukin-6/metabolism , Intestinal Mucosa/metabolism , Prognosis , SARS-CoV-2 , Saline Solution, Hypertonic/therapeutic use , Sodium, Dietary
11.
Intern Emerg Med ; 16(4): 853-862, 2021 06.
Article in English | MEDLINE | ID: covidwho-871549

ABSTRACT

BACKGROUND: The worldwide spread of SARS-CoV-2 has infected millions of people leading to over 0.3 million mortalities. The disruption of sodium homeostasis, tends to be a common occurrence in patients with COVID-19. METHODS AND RESULTS: A total of 1,254 COVID-19 patients comprising 124 (9.9%) hyponatremic patients (under 135 mmol/L) and 30 (2.4%) hypernatremic patients (over 145 mmol/L) from three hospitals in Hubei, China, were enrolled in the study. The relationships between sodium balance disorders in COVID-19 patients, its clinical features, implications, and the underlying causes were presented. Hyponatremia patients were observed to be elderly, had more comorbidities, with severe pneumonic chest radiographic findings. They were also more likely to have a fever, nausea, higher leukocyte and neutrophils count, and a high sensitivity C-reactive protein (HS-CRP). Compared to normonatremia patients, renal insufficiency was common in both hyponatremia and hypernatremia patients. In addition, hyponatremia patients required extensive treatment with oxygen, antibiotics, and corticosteroids. The only significant differences between the hypernatremia and normonatremia patients were laboratory findings and clinical complications, and patients with hypernatremia were more likely to use traditional Chinese medicine for treatment compared to normonatremia patients. This study indicates that severity of the disease, the length of stay in the hospital of surviving patients, and mortality were higher among COVID-19 patients with sodium balance disorders. CONCLUSION: Sodium balance disorder, particularly hyponatremia, is a common condition among hospitalized patients with COVID-19 in Hubei, China, and it is associated with a higher risk of severe illness and increased in-hospital mortality.


Subject(s)
COVID-19/complications , Hypernatremia/epidemiology , Hyponatremia/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , China , Female , Hospital Mortality , Hospitalization , Humans , Hypernatremia/diagnosis , Hypernatremia/therapy , Hyponatremia/diagnosis , Hyponatremia/therapy , Male , Middle Aged , Retrospective Studies , Young Adult
12.
Am J Case Rep ; 21: e925779, 2020 Aug 13.
Article in English | MEDLINE | ID: covidwho-713485

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. CONCLUSIONS Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Systemic Inflammatory Response Syndrome/virology , Antipyretics/therapeutic use , Aspirin/therapeutic use , COVID-19 , Child , Child, Preschool , Conjunctivitis/therapy , Conjunctivitis/virology , Coronavirus Infections/therapy , Exanthema/therapy , Exanthema/virology , Extracorporeal Membrane Oxygenation , Female , Fever/therapy , Fever/virology , Heart Failure/therapy , Heart Failure/virology , Humans , Hyponatremia/therapy , Hyponatremia/virology , Immunoglobulins, Intravenous , Lymphadenopathy/therapy , Lymphadenopathy/virology , Lymphopenia/therapy , Lymphopenia/virology , Male , Pandemics , Pneumonia, Viral/therapy , Respiration, Artificial , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Vasculitis/therapy , Vasculitis/virology
13.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-647341

ABSTRACT

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Subject(s)
Antidiuretic Agents/administration & dosage , Coronavirus Infections/therapy , Deamino Arginine Vasopressin/administration & dosage , Diabetes Insipidus, Neurogenic/therapy , Fluid Therapy/methods , Hypernatremia/therapy , Hyponatremia/therapy , Inappropriate ADH Syndrome/therapy , Pneumonia, Viral/therapy , Brain Injuries/complications , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Dehydration/therapy , Diabetes Insipidus/complications , Diabetes Insipidus/therapy , Diabetes Insipidus, Neurogenic/complications , Disease Management , Humans , Hyponatremia/etiology , Hyponatremia/prevention & control , Hypotonic Solutions/therapeutic use , Neurosurgical Procedures , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Postoperative Complications/therapy , Practice Guidelines as Topic , Saline Solution/therapeutic use , Shock/etiology , Shock/therapy
SELECTION OF CITATIONS
SEARCH DETAIL
...