Hyponatremia in COVID-19 Infection - Possible Causal Factors and Management

Abstract

since four days; followed by pain over the right flank, which radiated to the anterior abdomen. There was no dysuria, haematuria, lithuria, gravelurea; or history of passage of any fleshy material in the urine. Furthermore, there was no history of reduction in the urine output nor similar complaints in the past. He looked clinically unwell. He had tachycardia with a pulse rate of 120/minute, with a normal blood pressure and respiratory rate. His temperature was 38 °C, weight was 68 kg and a BMI of 22.6 kg/m 2. A systemic examination revealed tenderness and guarding in the right upper quadrant. A clinical diagnosis of acute right sided pyelonephritis was considered. Investigations revealed a haemoglobin of 13.1 gm/dL (normal range: 12 gm/ dL to 16 gm/dL); and a white cell count of 15000/mm 3 (normal range: 4000/mm 3 to 11000/mm 3), with polymorphs of 73%, lymphocytes of 22% and eosinophils of 03%. Urine analysis showed the urine to be positive for leucocyte esterase. BUN was 19 mg/dL (normal range 15 mg/dL to 40 mg/dL), serum creatinine 1.02 mg/dL (normal range 0.6 mg/dL to 1.4 mg/dl), blood sugar fasting and post-prandial were 80 mg/dL and 103 mg/ dL respectively, serum bilirubin was 0.4 mg/dL, serum albumin 4.2 gm/dL, serum AST/ALT was 19/22 IU/L. HIV, HBsAg, anti-HCV were non-reactive. His blood, urine were sterile, chest X-ray was normal, 2D echocardiography did not reveal any vegetation, serum procalcitonin was 0.6; and his serum beta galactomannan was 0.34 (Normal < 0.50). Ultrasound of the kidneys revealed an enlarged right kidney and a hypoechoic lesion in the inferior pole of right kidney. Contrast-enhanced computerised tomography (CECT) of the kidney, ureter and bladder (KUB) conducted on day two, revealed

Is There a Relationship between COVID-19 and Hyponatremia?

“…Hyponatremia is the most common electrolyte disorder seen in clinical practice and is associated with increased risk of death [ 12 ]. This electrolytic disequilibrium is classified in hypovolemic, euvolemic, and hypervolemic hyponatremia, each category’s therapeutic approach being different [ 2 ].…”

“…Hyponatremia was identified in approximately 35% of patients with pneumonia [ 2 ]. The presence of hyponatremia in patients with pneumonia has been associated with a higher mortality rate, indicating the need for an early diagnosis and proper therapeutic management, to improve the prognosis of these patients [ 2 ]. The literature also reports that approximately 60% of patients with COVID-19 and watery diarrhea have moderate hyponatremia.…”

“…As specified above, the hyponatremia etiology in patients with COVID-19 is multifactorial. According to existing data, the causes of hyponatremia include SIADH and digestive losses of sodium through diarrhea or vomiting [ 2 ]. The pathophysiological judgment is very important, because there are two therapeutic strategies, fluid restriction therapy and electrolytic substitution therapy.…”

“…The pathophysiological judgment is very important, because there are two therapeutic strategies, fluid restriction therapy and electrolytic substitution therapy. Thus, in the case of hypovolemic hyponatremia secondary to gastrointestinal fluid losses, reduced fluid intake or the use of diuretic therapy, guidelines impose initiation of electrolyte replacement therapy [ 2 ]. In the case of hyponatremia secondary to SIADH, fluid restriction is needed, that may associate hypertonic saline administration, depending on the level of neurological impairment.…”

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is part of the beta-coronavirus family and causes coronavirus disease 2019 (COVID-19) [ 1 , 2 ]. In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic, one of the most severe pandemics that humanity has faced over time [ 1 , 2 ]. Worldwide, there have been 45,921,698 cases of SARS-CoV-2 infection and 1,193,909 deaths, these numbers increasing alarmingly with each passing day [ 3 ].…”