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Peri A, Naldi L, Norello D, Fibbi B. Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19. Pituitary 2024:10.1007/s11102-024-01446-4. [PMID: 39196447 DOI: 10.1007/s11102-024-01446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Abstract
Hyponatremia is the most frequent electrolyte alteration among hospitalized patients and it has been reported in 20-40% of patients with SARS-CoV-2 (COVID-19) infection. Multiple causes of hyponatremia have been hypothesized in these patients. The syndrome of inappropriate antidiuresis (SIAD) has been considered one of the main reasons leading to hyponatremia in this condition. SIAD can be secondary to cytokines release, in particular IL-6. Positive pressure ventilation can be another cause of hyponatremia due to SIAD. Other possible etiologies of hyponatremia in COVID-19 patients can be related to secondary hypocortisolism, nausea, vomiting, heart and kidney damage. Similar to many other clinical conditions, there is strong evidence that hyponatremia is associated with a worse prognosis also in patients with COVID-19 infection. In particular, hyponatremia has been identified as an independent risk of ICU transfer, need of non-invasive ventilation and death. Hyponatremia in COVID-19 patients is in principle acute and symptomatic and should be treated as such, according to the published guidelines. Therefore, patients should be initially treated with i.v. hypertonic saline (3% NaCl) infusion and serum [Na+] should be frequently monitored, in order to remain within a safe rate of correction. There is evidence showing that serum [Na+] correction is associated with a better outcome in different pathologies, including COVID-19 infection.
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Affiliation(s)
- Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Florence, 50139, Italy.
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, AOU Careggi, Viale Pieraccini, 6, Florence, 50139, Italy.
| | - Laura Naldi
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, AOU Careggi, Viale Pieraccini, 6, Florence, 50139, Italy
| | - Dario Norello
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Florence, 50139, Italy
| | - Benedetta Fibbi
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Florence, 50139, Italy
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, AOU Careggi, Viale Pieraccini, 6, Florence, 50139, Italy
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Javaid MM, Shan J, Frederick R, Dreyer R, Gome JJ. Hyponatremia in COVID-19 Is Not Always Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): A Case Series. Cureus 2022; 14:e30939. [DOI: 10.7759/cureus.30939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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