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Hyponatremia and Encephalopathy in a 55-Year-old Woman with Syndrome of Inappropriate Antidiuretic Hormone Secretion as an Isolated Presentation of SARS-CoV-2 Infection.
Sherazi, Andleeb; Bedi, Puneet; Udevbulu, Ehizode; Rubin, Vadim; Alasadi, Lutfi; Spitalewitz, Samuel.
  • Sherazi A; Department of Nephrology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
  • Bedi P; Department of Nephrology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
  • Udevbulu E; Department of Pulmonary Critical Care, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
  • Rubin V; Department of Nephrology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
  • Alasadi L; Department of Nephrology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
  • Spitalewitz S; Department of Nephrology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Diseases / COVID-19 / Hyponatremia / Inappropriate ADH Syndrome Type of study: Diagnostic study / Prognostic study Topics: Long Covid Limits: Female / Humans / Middle aged Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: Ajcr.930135

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Diseases / COVID-19 / Hyponatremia / Inappropriate ADH Syndrome Type of study: Diagnostic study / Prognostic study Topics: Long Covid Limits: Female / Humans / Middle aged Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: Ajcr.930135