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2.
Pan Afr Med J ; 39: 199, 2021.
Article in English | MEDLINE | ID: covidwho-1449267

ABSTRACT

Coronavirus disease 2019 (COVID-19) was first reported in December 2019. The disease is caused by severe acute respiratory syndrome virus corona virus 2 (SARS-CoV-2). Mild respiratory symptoms are the most common manifestations of SARS-CoV-2, but new signs are constantly being discovered as it spreads. Disorders of sodium balance are increasingly described in patients with SARS-CoV-2. We report, here, the cases of two patients presented with COVID-19 and in whom we discovered sodium disorders. The first patient is a 74-year-old man who presented with fatal hypernatremia. The second patient is a 66-years-old man presented with COVID-19 and euvolemic hyponatremia attributed to syndrome of inappropriate anti-diuretic hormone secretion (SIADH). This hyponatremia persisted long after the respiratory signs disappeared. Sodium balance disorders are increasingly described in the literature; special attention should be paid to the electrolyte status of COVID-19 patients. Pathophysiological mechanisms associating SARS-CoV-2 with these disorders are being studied.


Subject(s)
COVID-19/complications , Hypernatremia/virology , Inappropriate ADH Syndrome/virology , Aged , Fatal Outcome , Humans , Hypernatremia/diagnosis , Hyponatremia/diagnosis , Hyponatremia/virology , Inappropriate ADH Syndrome/diagnosis , Male , Sodium/blood
3.
BMC Infect Dis ; 21(1): 1000, 2021 Sep 25.
Article in English | MEDLINE | ID: covidwho-1438261

ABSTRACT

BACKGROUND: The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise. CASE PRESENTATION: A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved. CONCLUSIONS: Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.


Subject(s)
COVID-19 , Hyponatremia , Inappropriate ADH Syndrome , Aged , COVID-19 Vaccines , Humans , Hyponatremia/etiology , Inappropriate ADH Syndrome/chemically induced , Male , SARS-CoV-2 , Vaccination
4.
BMC Infect Dis ; 21(1): 465, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-1238707

ABSTRACT

BACKGROUND: Coronavirus Disease-2019 (COVID-19) has been declared a global pandemic since March 11th, 2020. Despite emerging reports and literature covering a broad spectrum of COVID-19 clinical manifestations, facets of COVID-19 have not been fully elucidated. To the authors' concern, sinus bradycardia as a manifestation of COVID-19-induced syndrome of inappropriate antidiuretic hormone (SIADH) has never been reported before. CASE PRESENTATION: In this paper, we report a case of a 59-year-old male patient with confirmed COVID-19 initially presented with presyncope. Further investigations reveal sinus bradycardia related to COVID-19-induced SIADH. This case highlights the possibility of immuno-neuroendocrino-cardiovascular crosstalk resulting in an atypical manifestation of COVID-19: near syncope due to sinus bradycardia. CONCLUSIONS: Another possible cause of sinus bradycardia in COVID-19 is electrolyte imbalance due to COVID-19-related SIADH.


Subject(s)
Bradycardia/diagnosis , COVID-19/diagnosis , Inappropriate ADH Syndrome/diagnosis , SARS-CoV-2 , Bradycardia/complications , Bradycardia/physiopathology , COVID-19/complications , Diagnosis, Differential , Electrocardiography , Humans , Inappropriate ADH Syndrome/complications , Male , Middle Aged , Water-Electrolyte Balance
6.
Am J Case Rep ; 22: e930135, 2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1148367

ABSTRACT

BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic of 2020, varied presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. The present report is of a case of hyponatremia and encephalopathy due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as the main presentation of SARS-CoV-2 infection in a 55-year-old woman. CASE REPORT A 55-year-old woman with type II diabetes mellitus presented with confusion and slurring of speech, with a temperature of 38.5°C, heart rate of 120 bpm, blood pressure of 159/81 mmHg, and oxygen saturation of 98% on room air. She did not have edema on examination. Laboratory testing showed a low sodium level of 116 mEq/L (reference range, 135-145 mEq/L) with urine osmolarity of 364 mOsm/kg, urinary sodium of 69 mEq/L, urinary potassium of 15.6 mEq/L, and serum osmolarity of 251 mOsm/kg. The patient had normal serum thyroid-stimulating hormone and cortisol levels. A chest X-ray should no pulmonary infiltrates nor did a lumbar puncture reveal signs of infection. A real-time SARS-CoV-2 polymerase chain reaction assay was positive for COVID-19. Brain imaging with computed tomography was negative for acute infarct, intracranial hemorrhage, and mass effect. Based on findings from laboratory testing and physical examination, a diagnosis of SIADH was made. The patient was treated with 3% hypertonic saline, followed by salt tablets and fluid restriction, with improvement in her clinical symptoms and serum sodium level. CONCLUSIONS The present report is of a rare but previously reported association with SARS-CoV-2 infection. Encephalopathy and hyponatremia associated with SIADH without pneumonia or other symptoms of infection should be an indication for testing for SARS-CoV-2 infection.


Subject(s)
Brain Diseases/virology , COVID-19/complications , Hyponatremia/virology , Inappropriate ADH Syndrome/virology , COVID-19/diagnosis , Diabetes Mellitus, Type 2/complications , Female , Humans , Middle Aged , Saline Solution, Hypertonic/therapeutic use , Sodium/blood , Sodium Chloride/therapeutic use
8.
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.
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
13.
Transpl Infect Dis ; 22(6): e13355, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-574806

ABSTRACT

There is fast-emerging, cumulative clinical data on coronavirus disease 2019 (COVID-19) in kidney transplant recipients. Although respiratory tract symptoms are often the initial presentation among kidney transplant recipients who contract COVID-19, other clinical features which may indicate underlying SARS-CoV-2-related inflammation, such as gastrointestinal symptoms, are not uncommon. Hyponatremia can develop and may reflect underlying inflammation. Interferon-6 is an important pro-inflammatory cytokine involved in the pathogenesis of severe COVID-19 complications and may play a role in the inappropriately higher secretion of antidiuretic hormone leading to hyponatremia. This pathway is the so-called immuno-neuroendocrine interface. Hyponatremia in COVID-19 has been reported in a few case series of non-kidney transplant patients and only one reported kidney transplant recipient. However, the clinical course and prognostic value of hyponatremia in this population are not described in detail. We report a kidney transplant recipient who was infected with COVID-19 and exhibited severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion. Hyponatremia is one of the clinical presentations of COVID-19, although less common, and may occur more frequently in kidney transplant recipients. Thus, the possible underlying immuno-neuroendocrine relationship related to the inflammatory process of COVID-19 leading to hyponatremia and its prognostic value are reviewed.


Subject(s)
COVID-19/immunology , Hyponatremia/immunology , Immunosuppressive Agents/therapeutic use , Inappropriate ADH Syndrome/immunology , Kidney Transplantation , COVID-19/metabolism , Female , Graft Rejection/prevention & control , Humans , Hyponatremia/metabolism , Inappropriate ADH Syndrome/metabolism , Middle Aged , Neuroimmunomodulation/immunology , Neurosecretory Systems/immunology , SARS-CoV-2
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