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

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

  • Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report
    Nilzete Liberato Bresolin*, Pedro Docusse Junior, Maria Beatriz Cacese Shiozawa, Marina Ratier de Brito Moreira and Natalia Galbiatti Silveira Nilzete Liberato Bresolin*,Pedro Docusse Junior,Maria Beatriz Cacese Shiozawa,Marina Ratier de Brito Moreira,Natalia Galbiatti Silveira. Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report. . 2017 doi: 10.29328/journal.jcn.1001004; 1: 019-025
  • The outcome of Acute Kidney Injury in patients with severe Malaria
    João Egidio Romão Jr* and João Alberto Brandão João Egidio Romão Jr*,João Alberto Brandão. The outcome of Acute Kidney Injury in patients with severe Malaria. . 2017 doi: 10.29328/journal.jcn.1001007; 1: 048-054
  • AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis
    Hultin Sebastian*, Murali Karumathil and Nguyen Tam Hultin Sebastian*,Murali Karumathil,Nguyen Tam. AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis. . 2018 doi: 10.29328/journal.jcn.1001015; 2: 025-028
  • Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children
    Ali Mohammed Abu Zeid, Doaa Youssef Mohammed*, Amal Saeed AbdAlazeem, Anas Saad Elsayed mohammed Seddeeq and Ashraf Mohamed Elnaany Ali Mohammed Abu Zeid,Doaa Youssef Mohammed*,Amal Saeed AbdAlazeem,Anas Saad Elsayed mohammed Seddeeq,Ashraf Mohamed Elnaany. Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children. . 2019 doi: 10.29328/journal.jcn.1001032; 3: 093-099
  • Granulomatosis with polyangiitis (GPA) in a 76-year old woman presenting with pulmonary nodule and accelerating acute kidney injury
    Noor Sameh Darwich*, Melissa Schnell and L. Nicholas Cossey Noor Sameh Darwich*,Melissa Schnell,L. Nicholas Cossey. Granulomatosis with polyangiitis (GPA) in a 76-year old woman presenting with pulmonary nodule and accelerating acute kidney injury. . 2020 doi: 10.29328/journal.jcn.1001048; 4: 001-006
  • Biomarkers in acute kidney injury
    Nehomar Pajaro Galvis*, Jorge Rico-Fontalvo, Rodrigo Daza-Arnedo, Maria Ximena Cardona-Blanco, Emilio Abuabara-Franco, Victor Leal-Martínez, Jose Cabrales-Juan, José Correa-Guerrero, José Bohórquez-Rivero, José Sáenz-López, José Restom-Arrieta, Milton Rivera-Moreno, Estefany Rivera-Moreno, Maria Monterrosa-Robles, Alonso Pomares-Lara, Dayana Ayola-Rosales and Ana Alonso-Henriquez Nehomar Pajaro Galvis*,Jorge Rico-Fontalvo,Rodrigo Daza-Arnedo,Maria Ximena Cardona-Blanco,Emilio Abuabara-Franco,Victor Leal-Martínez,Jose Cabrales-Juan,José Correa-Guerrero,José Bohórquez-Rivero,José Sáenz-López,José Restom-Arrieta,Milton Rivera-Moreno,Estefany Rivera-Moreno,Maria Monterrosa-Robles,Alonso Pomares-Lara,Dayana Ayola-Rosales,Ana Alonso-Henriquez. Biomarkers in acute kidney injury. . 2020 doi: 10.29328/journal.jcn.1001056; 4: 027-035
  • Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology
    Emilio Rey-Vela, Jesús Muñoz, Rodrigo Daza-Arnedo, Rodrigo Daza-Arnedo, Katherin Portela-Buelvas, Nehomar Pájaro-Galvis*, Víctor Leal-Martínez, Emilio Abuabara-Franco, José Cabrales-Juan, Leonardo Marín, Lucas Daza, Samuel Cuadro, Emir Ortiz, María Raad-Sarabia, Cesar Ferrer, Alejandra Prada, Greisy González, Elkin Mendoza, Klearly Tinoco, Jorge Camacho, Joel Ortega, Carlos Tobón, Juan Montes, Jorge Coronado, Luis Salgado-Montiel, José Correa, Fabio Salas, Amilkar Almanza-Hurtado and Miguel Aguilar-Schorborg Emilio Rey-Vela,Jesús Muñoz,Rodrigo Daza-Arnedo,Rodrigo Daza-Arnedo,Katherin Portela-Buelvas,Nehomar Pájaro-Galvis*,Víctor Leal-Martínez,Emilio Abuabara-Franco,José Cabrales-Juan,Leonardo Marín,Lucas Daza,Samuel Cuadro,Emir Ortiz,María Raad-Sarabia,Cesar Ferrer,Alejandra Prada,Greisy González,Elkin Mendoza,Klearly Tinoco,Jorge Camacho,Joel Ortega,Carlos Tobón,Juan Montes,Jorge Coronado,Luis Salgado-Montiel,José Correa,Fabio Salas,Amilkar Almanza-Hurtado,Miguel Aguilar-Schorborg. Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology. . 2020 doi: 10.29328/journal.jcn.1001059; 4: 056-060
  • COVID-19 related rhabdomyolysis
    Alejandro Munoz-Martinez, Maham Akbar Waheed, Kenar D Jhaveri and Geurys Rojas-Marte* Alejandro Munoz-Martinez,Maham Akbar Waheed,Kenar D Jhaveri,Geurys Rojas-Marte*. COVID-19 related rhabdomyolysis. . 2020 doi: 10.29328/journal.jcn.1001061; 4: 065-069
  • Modification of the Renal Angina Index for identifying the need for renal replacement therapy in critically ill pediatric patients
    Erin K Stenson*, John T Brinton, Liz Beil, Danielle E Soranno and Katja M Gist Erin K Stenson*,John T Brinton,Liz Beil,Danielle E Soranno,Katja M Gist. Modification of the Renal Angina Index for identifying the need for renal replacement therapy in critically ill pediatric patients. . 2020 doi: 10.29328/journal.jcn.1001062; 4: 070-076
  • Unusual presentation of oxalate nephropathy causing acute kidney injury: A case report
    Anas Diab*, Michelle M Neuman, Kareem Diab and Daniel Gordon Anas Diab*,Michelle M Neuman,Kareem Diab,Daniel Gordon. Unusual presentation of oxalate nephropathy causing acute kidney injury: A case report. . 2020 doi: 10.29328/journal.jcn.1001063; 4: 077-079

Recently Viewed

Read More

Most Viewed

Read More

Help ?