Abstract

Case Report

Persistent symptomatic hyponatremia post-COVID 19: case report

Haifa Alshwikh, Ferial Alshwikh and Halla Elshwekh*

Published: 16 May, 2022 | Volume 6 - Issue 2 | Pages: 058-062

Background: Hyponatremia associated with COVID-19 is considered an independent risk factor for a prolonged hospital stay, intensive care admission, and death, but its causes and treatment are not yet well known. Many workers attribute hyponatremia associated with COVID-19 to acute kidney injury and nephropathy associated with the disease. Others suggest that it is related to the syndrome of inappropriate antidiuretic hormone secretion, sepsis, or hypothalamic-pituitary dysfunction. We report a case of persistent acute hyponatremia in a COVID-19 patient with multifactorial etiology. 
Case presentation: A managed 77 years with known hypertension, type II DM, ischemic heart disease, chronic kidney disease (stage 3B and on treatment) presented with post-COVID-19 pneumonia, confusion, fever, generalized fatigability, dizziness, and lower limb edema. COVID-19 ad has been diagnosed two weeks earlier with a positive nasopharyngeal swab and was managed with dexamethasone, 10 mg oral for 10 days, azithromycin, 500 mg once orally, and levofloxacin, 500 mg once orally. At presentation, laboratory investigation showed hyponatremia (127.7 mg/dl). 
Conclusion: The etiology of hyponatremia associated with COVID-19 is different from that in other cases of hyponatremia and its management should be individualized according to patient history and clinical assessment, and effort is needed to determine the exact cause.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001090 Cite this Article Read Full Article PDF

Keywords:

Hyponatremia; Kidney injury; COVID-19

References

  1. José Carlos de la Flor M, Francisco Valga A, Alexander M, Miguel Rodeles del P. Hyponatremia in COVID-19 Infection - Possible Causal Factors and Management. J Clin Nephrol Ren Care. 2020;6(2):53–6.
  2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Erratum in: JAMA. 2021 Mar 16;325(11):1113. PMID: 32031570; PMCID: PMC7042881.
  3. Hirsch JS, Uppal NN, Sharma P, Khanin Y, Shah HH, Malieckal DA, Bellucci A, Sachdeva M, Rondon-Berrios H, Jhaveri KD, Fishbane S, Ng JH; Northwell Nephrology COVID-19 Research Consortium. Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19. Nephrol Dial Transplant. 2021 May 27;36(6):1135-1138. doi: 10.1093/ndt/gfab067. PMID: 33724428; PMCID: PMC7989196.
  4. Tzoulis P, Waung JA, Bagkeris E, Hussein Z, Biddanda A, Cousins J, Dewsnip A, Falayi K, McCaughran W, Mullins C, Naeem A, Nwokolo M, Quah H, Bitat S, Deyab E, Ponnampalam S, Bouloux PM, Montgomery H, Baldeweg SE. Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19. J Clin Endocrinol Metab. 2021 May 13;106(6):1637-1648. doi: 10.1210/clinem/dgab107. PMID: 33624101; PMCID: PMC7928894.
  5. De Carvalho H, Letellier T, Karakachoff M, Desvaux G, Caillon H, Papuchon E, et al. Hyponatremia is associated with poor outcome in COVID-19. J Nephrol [Internet]. 2021;(0123456789). Available from: https://doi.org/10.1007/s40620-021-01036-8
  6. Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, Zou W, Zhan J, Wang S, Xie Z, Zhuang H, Wu B, Zhong H, Shao H, Fang W, Gao D, Pei F, Li X, He Z, Xu D, Shi X, Anderson VM, Leong AS. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005 Aug 1;202(3):415-24. doi: 10.1084/jem.20050828. Epub 2005 Jul 25. PMID: 16043521; PMCID: PMC2213088.
  7. De Carvalho H, Richard MC, Chouihed T, Goffinet N, Le Bastard Q, Freund Y, et al. Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case–control study. Intern Emerg Med [Internet]. 2021;(0123456789). https://doi.org/10.1007/s11739-021-02632-z
  8. Hong X, Chi Z, Liu G, Huang H, Guo S. Analysis of early renal injury in COVID-19 and diagnostic value of multi-index combined detection. 2020;1–23.
  9. Meijers B, Hilbrands LB. The clinical characteristics of coronavirus-associated nephropathy. Nephrol Dial Transplant. 2020 Aug 1;35(8):1279-1281. doi: 10.1093/ndt/gfaa197. PMID: 32871591; PMCID: PMC7499749.
  10. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, Hazzan AD, Fishbane S, Jhaveri KD; Northwell COVID-19 Research Consortium; Northwell Nephrology COVID-19 Research Consortium. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 Jul;98(1):209-218. doi: 10.1016/j.kint.2020.05.006. Epub 2020 May 16. PMID: 32416116; PMCID: PMC7229463.
  11. Khan AA, Ata F, Munir W, Yousaf Z. Fluid Replacement Versus Fluid Restriction in COVID-19 Associated Hyponatremia. Cureus. 2020 Jul 8;12(7):e9059. doi: 10.7759/cureus.9059. PMID: 32782878; PMCID: PMC7413320.
  12. Hu W, lv X, Li C, Xu Y, Qi Y, Zhang Z, et al. Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study. Intern Emerg Med [Internet]. 2020;(0123456789). https://doi.org/10.1007/s11739-020-02515-9
  13. Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, Rubio MA, Maroun-Eid C, Arroyo-Espliguero R, Romero R, Becerra-Muñoz VM, Uribarri A, Feltes G, Trabattoni D, Molina M, García Aguado M, Pepe M, Cerrato E, Alfonso E, Castro Mejía AF, Roubin SR, Buzón L, Bondia E, Marin F, López Pais J, Abumayyaleh M, D'Ascenzo F, Rondano E, Huang J, Fernandez-Perez C, Macaya C, de Miguel Novoa P, Calle-Pascual AL, Estrada Perez V, Runkle I; HOPE COVID-19 investigators. Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne). 2020 Nov 30;11:599255. doi: 10.3389/fendo.2020.599255. PMID: 33329400; PMCID: PMC7734292.
  14. Shetty AA, Tawhari I, Safar-Boueri L, Seif N, Alahmadi A, Gargiulo R, et al. COVID-19–Associated Glomerular Disease. J Am Soc Nephrol [Internet]. 2021 Jan 1;32(1):33 LP – 40. http://jasn.asnjournals.org/content/32/1/33.abstract
  15. Widiasta A, Sribudiani Y, Nugrahapraja H, Hilmanto D, Sekarwana N, Rachmadi D. Potential role of ACE2-related microRNAs in COVID-19-associated nephropathy. Non-coding RNA Res [Internet]. 2020;5(4):153–66. https://www.sciencedirect.com/science/article/pii/S2468054020300561

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