Abstract: PO0811
Low-Sodium Disorders and the 2019 Novel Coronavirus Disease (COVID-19)
Session Information
- COVID-19: Clinical Characteristics and Cases
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 000 Coronavirus (COVID-19)
Authors
- Gill, Jasmeet, Baylor University Medical Center at Dallas, Dallas, Texas, United States
- Guo, Xunxi Susan, Dallas Nephrology Associates, Dallas, Texas, United States
- Akinfolarin, Akinwande A., Dallas Nephrology Associates, Dallas, Texas, United States
- Mehta, Ankit, Baylor University Medical Center at Dallas, Dallas, Texas, United States
Introduction
COVID-19 have been well characterized with hallmarks of pneumonia and respiratory failure. Hyponatremia is a well reported finding in patients with pneumonia. However only few reports of sodium disorders have been directly attributable to the disease. We report three different presentations of hyponatremia in COVID19 patients.
Case Description
1. 70 year old man with hypertension, diabetes presented with dyspnea. He was clinically euvolemic. Chest X-ray (CXR) showed bilateral interstitial and airspace opacities. Laboratory data revealed, serum sodium 122 meq/L, serum osmolality 264 mosm/kg, urine osmolality 579 mosm/kg and urine sodium 153 mmol/L. A diagnosis of hyponatremia secondary to the Syndrome of inappropriate Antidiuretic Hormone (SIADH) was made and the patient was treated with oral urea and fluid restriction.
2. 50 year old man with chronic alcohol abuse presented with bilateral calf soreness. CXR revealed increased interstitial markings. Laboratory data showed serum sodium 113 meq/L, serum osmolality 251 mosm/kg, urine osmolality 426 mosm/kg and urine sodium 14 mmol/L. Hyponatremia was attributed to a low solute state. Serum sodium improved with normal saline infusion.
3. 69 year old female with hypertension admitted with vomiting and diarrhea. CXR showed diffuse pulmonary infiltrates. Initial laboratory data revealed serum sodium of 126 meq/L, serum osmolality 260 mosm/kg. Serum sodium recovered as diarrhea resolved. However, eight days after starting therapy with Selinexor, a nuclear transport inhibitor, serum Na declined to 128 meq/L, serum osmolality 275 mosm/kg, urine sodium 29 mmol/L, urine osmolality 372 mosm/Kg. SIADH was attributed to Selinexor therapy. Sodium improved with oral sodium chloride therapy and fluid restriction
Discussion
Incidence of Hyponatremia due to SIADH in community acquired penumonia is 8-31% in adult patients. To the best of our knowledge, there have only been two case reports of SIADH in COVID-19 disease from Switzerland. Hence, it is unclear if SIADH is the predominant presentation of hyponatremia with COVID-19. The etiology of hyponatremia could be multifactorial as seen in the cases above. Clinical assessment of volume status and urine studies including osmolality and sodium with a thorough review of medications is the key to differentiate causes of hyponatremia and determining adequate management.