Related Experiment Video
Updated: Jun 6, 2025
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Coronavirus Disease 2019 (COVID-19)-Induced Hyponatremia: A Challenging Geriatric Case
Amogh Kiran1, Vansh Marwaha2, Daravie Pel3
1Primary Care, Avalon University School of Medicine, Willemstad, CUW.
Insights
This case report details a 91-year-old woman with COVID-19 who experienced persistent hyponatremia. Management focused on hypovolemia and poor intake, not SIADH, leading to successful electrolyte correction.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Nephrology
Background:
- COVID-19 can cause diverse complications, including electrolyte disturbances and organ dysfunction.
- Hyponatremia is a common electrolyte imbalance, particularly in elderly patients with comorbidities.
Observation:
- A 91-year-old female with chronic kidney disease (CKD) stage 3 presented with hypoxemic respiratory failure, transaminitis, and persistent hyponatremia during COVID-19 infection.
- Initial suspicion of SIADH was challenged by normal urine studies and osmolality, suggesting hypovolemic hyponatremia due to poor oral intake and volume depletion.
- Transaminitis resolved with supportive care, enabling remdesivir treatment.
Findings:
- The patient's hyponatremia was successfully corrected gradually without complications through individualized management.
- This case underscores that hyponatremia in COVID-19 can stem from factors beyond SIADH, such as dehydration and reduced oral intake.
- The resolution of transaminitis allowed for timely antiviral therapy.
Implications:
- COVID-19 management requires careful monitoring for and individualized treatment of electrolyte imbalances, especially hyponatremia.
- Recognizing diverse causes of hyponatremia, including hypovolemia, is crucial for effective patient care during COVID-19.
- Comprehensive care addressing systemic effects of COVID-19 is essential for optimizing patient outcomes.
Abstract:
Coronavirus disease 2019 (COVID-19) has presented numerous challenges to the medical community, including atypical complications such as electrolyte imbalances and organ dysfunction. This case report describes a 91-year-old female with a history of chronic medical conditions, including chronic kidney disease (CKD) stage 3, who presented with hypoxemic respiratory failure, transaminitis, and persistent hyponatremia during the course of her COVID-19 infection. Despite initial suspicion of the syndrome of inappropriate antidiuretic hormone secretion (SIADH), caused by elevated antidiuretic hormone (ADH), the patient's normal osmolality and sodium excretion suggested other contributing factors, such as poor oral intake (per os, PO), volume depletion, and pseudo-acute kidney injury (pseudo-AKI) leading to hypovolemic hyponatremia. Her transaminitis resolved with supportive care, allowing for the safe initiation of remdesivir. The patient's gradual correction of hyponatremia without complications highlights the importance of individualized management. This case highlights the varied and systemic effects of COVID-19, emphasizing the need for comprehensive care and monitoring of electrolyte disturbances during hospitalization.
Related Concept Videos
01:25Regulation of Water Intake
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:29Disorder of Water Balance
Dehydration
Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
Symptoms primarily include intense...
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
01:24Renal Tubule and Collecting Duct
Proximal Convoluted Tubule (PCT):
The PCT is the initial segment of the renal tubule, extending from the Bowman's capsule that encloses the glomerulus. Its convoluted structure and microvilli-lined cells increase the surface area for reabsorption. The PCT reabsorbs glucose, amino acids, sodium, and water from the filtrate, ensuring essential...
01:29Renal Regulation of Acid-Base Balance
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...