ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

Christ‐Crain, Mirjam; Hoorn, Ewout J.; Sherlock, Mark; Thompson, Chris; Wass, John

doi:10.1530/eje-20-0338

Cited by 53 publications

(67 citation statements)

References 35 publications

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“…Recently, more and more studies highlighted the positive correlations between blood glucose levels and COVID-19 [4,5].COVID-19 patients with hyperglycemia have a crude mortality of about 7.3%, much higher than that of COVID-19 patients with normal blood glucose levels (0.9%) [6]. In diabetic patients, the percentage of patients who need intensive care was as high as 22.2% [7].…”

Section: Introductionmentioning

confidence: 99%

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

Huang

Guo

Zhou

et al. 2020

Diabetes Research and Clinical Practice

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Coronavirus disease 2019 (COVID-19) which is a novel pneumonia can rapidly progress to acute respiratory distress syndrome, septic shock, and multiple organ dysfunction syndrome. It has appeared in 196 countries around the world. We aimed to clarify the associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes. Methods: We performed a retrospective, single-center study of 151 patients without dia

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Section: Introductionmentioning

confidence: 99%

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

Huang

Guo

Zhou

et al. 2020

Diabetes Research and Clinical Practice

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“…Hyponatremia has been reported in patients with lower respiratory tract infections and can be hypervolemic, euvolemic, or hypovolemic, with different underlying pathophysiological mechanisms [1]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been recently reported to manifest as hyponatremia secondary to syndrome of inappropriate anti diuretic hormone (SIADH ) [2][3][4][5][6]. However, hyponatremia can be due to other etiologies as well.…”

Section: Introductionmentioning

confidence: 99%

Fluid Replacement Versus Fluid Restriction in COVID-19 Associated Hyponatremia

Khan¹,

Ata²,

Munir³

et al. 2020

Cureus

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Hyponatremia is one of the most frequently observed electrolyte abnormalities in coronavirus disease 2019 (COVID-19). Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. However, it is important to rule out other etiologies of hyponatremia in such cases keeping in mind the effect of an alternate etiology on patient management and outcome. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. A 52-year-old Filipino gentleman presented with a three-week history of diarrhea and symptomatic hyponatremia. There was no history of fever or respiratory symptoms. Physical examination revealed a dehydrated and confused middle-aged gentleman. Labs revealed lymphopenia, thrombocytopenia, and severe hyponatremia (108 mmol/L). Blood cultures and stool workup were negative. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal swab was positive. Hyponatremia workup excluded SIADH. The patient had hypovolemic hyponatremia due to gastrointestinal (GI) losses and was managed with saline infusion for correction of hyponatremia with improvement in his clinical status. Hyponatremia in COVID-19 is not only secondary to SIADH but can also be due to other etiologies. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality.

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“…General recommendations for social distancing should also apply for these patients.  Patients with diabetes insipidus need to be informed of the risk of disturbances in the electrolyte and fluid balance in the context of COVID-19 infection (7).…”

Section: How Should Current Patients With Pituitary Tumours Be Advisementioning

confidence: 99%

Endocrinology in the time of COVID-19: Management of pituitary tumours

Fleseriu

Dekkers

Karavitaki

2020

European Journal of Endocrinology

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Disclaimer: Due to the emerging nature of the COVID-19 crisis this document is not based on extensive systematic review or meta-analysis, but on rapid expert consensus. The document should be considered as guidance only; it is not intended to determine an absolute standard of medical care. Healthcare staff need to consider individual circumstances when devising the management plan for a specific patient. AbstractPatients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity, cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas for these patients, and we provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status.We consider that utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.

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ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

Cited by 53 publications

References 35 publications

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

The associations between fasting plasma glucose levels and mortality of COVID-19 in patients without diabetes

Fluid Replacement Versus Fluid Restriction in COVID-19 Associated Hyponatremia

Endocrinology in the time of COVID-19: Management of pituitary tumours

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