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Abstract: PO0803

A Case of Severe Hyponatremia in a Patient with COVID-19

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Uppal, Nupur N., Northwell Health, Manhasset, New York, United States
  • Flores Chang, Bessy Suyin, Northwell Health, Manhasset, New York, United States
  • Andrade paz, Hugo, Northwell Health, Manhasset, New York, United States
  • Sachdeva, Mala, Northwell Health, Manhasset, New York, United States
Introduction

Hyponatremia is a common electrolyte disturbance seen in association with conditions such as malignancy and infections. In the recent literature, hyponatremia has been linked to SARS-CoV2 infection. To date, the most likely reported etiology of hyponatremia in setting of COVID-19 has been SIADH. We describe a severe case of hyponatremia, not due to SIADH, seen in a patient with COVID-19

Case Description

49-year-old male with history of hypertension, hyperlipidemia, positive novel coronavirus nasopharyngeal swab done as outpatient, presented to the emergency department with fever, cough and dyspnea for a week. On admission, he was afebrile with respiratory rate of 18 and oxygen saturation of 84% on ambient air. His BP was not low, and heart rate ranged from 95-105 beats per minute. Pulmonary examination revealed rales bilaterally. Initial laboratory test showed serum sodium of 104 mEq/L and serum creatinine 0.58 mg/dL. Additionally, C-reactive protein was elevated to 7.19, serum ferritin elevated at 1798 and D-dimer was 158. CXR showed bilateral infiltrates. Serum osmolality was low at 217, and urine studies showed elevated urine osmolality (328) and low urine sodium (< 35), suggestive for diagnosis of hypotonic hyponatremia from volume depletion. He received treatment with 3% hypertonic saline with a subsequent decrease in urine osmolality to 83. Serum sodium rapidly corrected to 118 requiring hypotonic fluids to manage overcorrection. Subsequently, serum sodium improved to a level of 133 mEq/L in the next 5 days after admission

Discussion

As the COVID-19 pandemic continues to evolve, cases of related hyponatremia in this setting are being reported, mostly SIADH being the underlying etiology. Various mechanisms for SIADH development, including cytokine storm, and hypoxic pulmonary vasoconstriction have been postulated, however, the common aspect of volume depleted state in setting of viral infection, leading to appropriate ADH release should not be forgotten