Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City

Frontera, Jennifer A.; Valdes, Eduard; Huang, Joshua Zhexue; Lewis, Ariane; Lord, Aaron; Zhou, Ting; Kahn, D. Ethan; Melmed, Kara; Czeisler, Barry; Yaghi, Shadi; Scher, Erica; Wısnıewskı, Thomas; Balcer, Laura J.; Hammer, Elizabeth J.

doi:10.1097/ccm.0000000000004605

Cited by 79 publications

(138 citation statements)

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“…32 Some studies have shown that the majority of COVID-19 cases have electrolyte abnormalities correlated with a high risk of intensive care needs, mechanical ventilation and encephalopathy events with high mortality rates and longer treatment days. 33,34 Comparable to some other studies, most cases found that most cases had hyponatremia (55.6%). Tezcan, et al mentions that hyponatremia is the most common electrolyte abnormality compared to other electrolyte abnormalities.…”

Section: Discussionsupporting

confidence: 59%

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

Haryati

Isa

Assagaf

et al. 2021

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Background: Corona Virus Disease (COVID-19) has become a global pandemic and has spread to more than 200 countries including Indonesia. South Kalimantan is one of the provinces in Indonesia that has a high COVID-19 mortality rate (case fatality rate 4.1%). Information about characteristic of mortality patients with SARS-CoV-2 infection in Indonesia was limited. The objective of this study to describe clinical characteristics of COVID-19-confirmed deaths at Ulin Regional Hospital Banjarmasin, as a referral hospital in South KalimantanMethods: Medical records of 108 hospitalized patients dying with COVID-19 between March until August 2020 were collected. The recorded information included gender, age, onset and severity of disease, comorbidities, symptoms, signs, and laboratory findingsResults: The 108 confirmed cases of COVID-19 deaths were mostly male (73.1%) aged <65 years old (85.2%). About 84% of the cases had at least one comorbidity or more, like hypertension (44.4%), obesity (38%), and diabetes mellitus (32.4%). Common early symptoms were fever (91.7%) and shortness of breath (89.8%). Laboratory findings included lympocytopenia and eosinophilopenia (80.6% and 72.2%), increased neutrophil lymphocyte ratio (NLR; 86.1%), decreased absolute lymphocyte count (ALC; 72.2%), and hyponatremia (55.6%). Elevated C-reactive protein (CRP; 92.6%), lactate dehydrogenase (LDH; 91.7%), serum glutamic oxaloacetic transaminases (SGOT; 82.4%), and creatinine levels (57.4%). The majority of non survivors were severe-critical stage with severe acute respiratory distress syndrome (ARDS).Conclusion: In this depictive study, patients with comorbidities and severe-critical stage are at risk of death. Laboratory abnormalities were common in non survivors. Shortness of breath may indicate poor prognosis of COVID-19.

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Section: Discussionsupporting

confidence: 59%

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

Haryati

Isa

Assagaf

et al. 2021

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“…Potential TME etiologies were identified a priori and included the following: electrolyte abnormalities (hyponatremia or hypernatremia, hypoglycemia or hyperglycemia, hypocalcemia or hypercalcemia, hypomagnesemia or hypermagnesemia, or hypophosphatemia or hyperphosphatemia; acidosis/acidemia; or alkalosis/alkalemia), organ failure (renal failure/uremia, liver failure, or pulmonary failure [including hypoxemia or hypercarbia]), hypertensive encephalopathy, sepsis or active infection (from either SARS-CoV-2 or another infection), fever, nutritional deficiency (Wernicke encephalopathy, vitamin B 12 deficiency, or niacin deficiency), or environmental injury (hypothermia or exposure or poisoning) [ 7 , 13 ]. Hypoxic-ischemic encephalopathy (HIE) (also known as anoxic or hypoxic brain injury) was defined as a global cerebral insult due to oxygen deprivation to the brain or lack of perfusion to the brain caused by systemic hypoxemia, hypotension, or cardiac arrest [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…Multiple studies have identified neurological events in the context of recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1][2][3][4][5][6][7][8]. Many of these complications are sequelae of severe illness or represent secondary effects of multisystem organ failure.…”

Section: Introductionmentioning

confidence: 99%

Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19

et al. 2021

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Background Toxic metabolic encephalopathy (TME) has been reported in 7–31% of hospitalized patients with coronavirus disease 2019 (COVID-19); however, some reports include sedation-related delirium and few data exist on the etiology of TME. We aimed to identify the prevalence, etiologies, and mortality rates associated with TME in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients. Methods We conducted a retrospective, multicenter, observational cohort study among patients with reverse transcriptase–polymerase chain reaction-confirmed SARS-CoV-2 infection hospitalized at four New York City hospitals in the same health network between March 1, 2020, and May 20, 2020. TME was diagnosed in patients with altered mental status off sedation or after an adequate sedation washout. Patients with structural brain disease, seizures, or primary neurological diagnoses were excluded. The coprimary outcomes were the prevalence of TME stratified by etiology and in-hospital mortality (excluding comfort care only patients) assessed by using a multivariable time-dependent Cox proportional hazards models with adjustment for age, race, sex, intubation, intensive care unit requirement, Sequential Organ Failure Assessment scores, hospital location, and date of admission. Results Among 4491 patients with COVID-19, 559 (12%) were diagnosed with TME, of whom 435 of 559 (78%) developed encephalopathy immediately prior to hospital admission. The most common etiologies were septic encephalopathy ( n = 247 of 559 [62%]), hypoxic-ischemic encephalopathy (HIE) ( n = 331 of 559 [59%]), and uremia ( n = 156 of 559 [28%]). Multiple etiologies were present in 435 (78%) patients. Compared with those without TME ( n = 3932), patients with TME were older (76 vs. 62 years), had dementia (27% vs. 3%) or psychiatric history (20% vs. 10%), were more often intubated (37% vs. 20%), had a longer hospital length of stay (7.9 vs. 6.0 days), and were less often discharged home (25% vs. 66% [all P < 0.001]). Excluding comfort care patients ( n = 267 of 4491 [6%]) and after adjustment for confounders, TME remained associated with increased risk of in-hospital death ( n = 128 of 425 [30%] patients with TME died, compared with n = 600 of 3799 [16%] patients without TME; adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.02–1.52, P = 0.031), and TME due to hypoxemia conferred the highest risk ( n = 97 of 233 [42%] patients with HIE died, compared with n = 631 of 3991 [16%] patients without HIE; aHR 1.56, 95% CI 1.21–2.00, P = 0.001). Conclusions TME occurred in one in eight hospitalized patients with COV...

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“…SARS-CoV-2 virus encephalitis also has been described [ 3 , 4 ]. Unsurprisingly, SIADH-related hyponatremia has been identified in patients hospitalized for COVID-19 [ 5 – 7 ]. Observational studies have noted an association between interleukin (IL)-6 levels and hyponatremia and suggest that IL-6-mediated inflammation and non-osmotic antidiuretic hormone (ADH) release is the underlying pathophysiology [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Unsurprisingly, SIADH-related hyponatremia has been identified in patients hospitalized for COVID-19 [ 5 – 7 ]. Observational studies have noted an association between interleukin (IL)-6 levels and hyponatremia and suggest that IL-6-mediated inflammation and non-osmotic antidiuretic hormone (ADH) release is the underlying pathophysiology [ 7 , 8 ]. Given that brain imaging was normal in our patient, we ruled out direct CNS involvement with SARS-CoV-2 as a cause of encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia and Encephalopathy in a 55-Year-old Woman with Syndrome of Inappropriate Antidiuretic Hormone Secretion as an Isolated Presentation of SARS-CoV-2 Infection

et al. 2021

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Patient: Female, 55-year-old Final Diagnosis: COVID-19 • SIADH Symptoms: AMS • seizure Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Nephrology Objective: Unknown ethiology Background: During the coronavirus disease 2019 (COVID-19) pandemic of 2020, varied presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. The present report is of a case of hyponatremia and encephalopathy due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as the main presentation of SARS-CoV-2 infection in a 55-year-old woman. Case Report: A 55-year-old woman with type II diabetes mellitus presented with confusion and slurring of speech, with a temperature of 38.5°C, heart rate of 120 bpm, blood pressure of 159/81 mmHg, and oxygen saturation of 98% on room air. She did not have edema on examination. Laboratory testing showed a low sodium level of 116 mEq/L (reference range, 135–145 mEq/L) with urine osmolarity of 364 mOsm/kg, urinary sodium of 69 mEq/L, urinary potassium of 15.6 mEq/L, and serum osmolarity of 251 mOsm/kg. The patient had normal serum thyroid-stimulating hormone and cortisol levels. A chest X-ray should no pulmonary infiltrates nor did a lumbar puncture reveal signs of infection. A real-time SARS-CoV-2 polymerase chain reaction assay was positive for COVID-19. Brain imaging with computed tomography was negative for acute infarct, intracranial hemorrhage, and mass effect. Based on findings from laboratory testing and physical examination, a diagnosis of SIADH was made. The patient was treated with 3% hypertonic saline, followed by salt tablets and fluid restriction, with improvement in her clinical symptoms and serum sodium level. Conclusions: The present report is of a rare but previously reported association with SARS-CoV-2 infection. Encephalopathy and hyponatremia associated with SIADH without pneumonia or other symptoms of infection should be an indication for testing for SARS-CoV-2 infection.

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Prevalence and Impact of Hyponatremia in Patients With Coronavirus Disease 2019 in New York City

Abstract: Supplemental Digital Content is available in the text.

Cited by 79 publications

References 29 publications

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19

Hyponatremia and Encephalopathy in a 55-Year-old Woman with Syndrome of Inappropriate Antidiuretic Hormone Secretion as an Isolated Presentation of SARS-CoV-2 Infection

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