Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19

Rondon‐Berrios, Helbert; Abate, Mersema; Andrade, Hugo Paz; Barnett, Richard; Bellucci, Alessandro; Bhaskaran, Madhu; Corona, A.; Chang, Bessy Suyin Flores; Finger, Mark; Fishbane, Steven; Gitman, Michael; Halinski, Candice; Hasan, Shamir; Hazzan, Azzour D.; Hirsch, Jamie S.; Hong, Susana; Jhaveri, Kenar D.; Khanin, Yuriy; Kuan, Aireen; Madireddy, Varun; Malieckal, Deepa; Muzib, Abdulrahman; Nair, Gayatri; Nair, Vinay; Ng, Jia H.; Parikh, Rushang; Ross, Daniel W.; Sakhiya, Vipulbhai; Sachdeva, Mala; Schwarz, Richard P.; Shah, Hitesh H.; Sharma, Purva; Singhal, Pravin C.; Uppal, Nupur N.; Wanchoo, Rimda

doi:10.1093/ndt/gfab067

Cited by 41 publications

(93 citation statements)

References 14 publications

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“…Interestingly, whereas almost two of every five COVID-19 patients developed hypernatremia, this occurred in only 8% of the non-COVID-19 respiratory illness patients. This finding contradicts earlier work by—among others—Atila et al, 5 who found that the occurrence of hypernatremia was comparable among their COVID-19 group and control group, and Hirsch et al, 6 who found a compound hypernatremia prevalence of only 7% (3.2% for mild hypernatremia, defined as a plasma sodium concentration between 145 and 149 mmol/L, and 3.8% for severe hypernatremia, defined as a plasma sodium concentration of 150 mmol/L or above) in a large cohort of 9946 COVID-19 patients. Similar hypernatremia prevalence numbers have been reported by other authors.…”

Section: Discussioncontrasting

confidence: 68%

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COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

et al. 2021

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Objective: To investigate the occurrence of disorders of water and sodium balance in COVID-19 in our clinic. Methods: In this retrospective chart review, patients were included if a polymerase chain test result for SARS-CoV-2 was obtained and if at least one plasma sodium concentration measurement was obtained during the period from March to June 2020. The occurrences of hyponatremia and hypernatremia were compared between 193 SARS-CoV-2-positive and 138 SARS-CoV-2-negative patients. A χ² test was used to determine statistical significance, and the corresponding p-values were calculated. Results: Hypernatremia was significantly more frequently observed in COVID-19 patients, in 38% (74 of 193), versus only 8% in SARS-CoV-2-negative patients (11 of 138) ( p < 0.01). Hyponatremia was observed in 34% of the included COVID-19 patients (65 of 193) versus 24% of SARS-CoV-2-negative patients (33 of 138). In 12% of all COVID-19 patients (23 of 193), both hyponatremia and hypernatremia were observed at some point during their admission. Among the non-COVID-19 patients, only 4% showed these plasma sodium concentration fluctuations (5 of 138). The mortality rate among the hospitalized COVID-19 patients was 23% (45 of 193). Correcting for double-counting, more than 71% (32 of 45) of the deceased COVID-19 patients developed dysnatremia (hyponatremia, hypernatremia or both) versus 57% (84 out of 148) of the surviving COVID-19 patients. Conclusion: Disorders of water and sodium balance—and especially hypernatremia—seem to be a common occurrence in COVID-19 patients. This has important implications for the treatment of COVID-19 patients.

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Section: Discussioncontrasting

confidence: 68%

“… 2 A growing body of evidence shows that COVID-19 is also accompanied by several extra-pulmonary phenomena, such as disorders of the water and sodium balance. 5 – 7…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

et al. 2021

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“…Initial data suggested that hypernatraemia, in contrast to other critically ill patients, is not a risk factor for severe mortality in COVID-19 25 . More recent data, however, show that hypernatraemia is associated with adverse outcomes and mortality, similar to other critically ill patients [4][5][6][7] .…”

Section: Acute Infection With Suspected or Confirmed Covid-19mentioning

confidence: 69%

“…Berni et al showed a prevalence of hyponatremia of 22.9%, which is in the range of most other literature showing a prevalence of around 20-30% [5][6][7]9 . An even higher prevalence of 40% has been shown in a large study in 10'000 patients across 13 hospitals in a New York health system 4 .…”

Section: What To Look At If Patients With Hyponatremia Are Admitted To the Hospital With Acute Infection With Covid-19mentioning

confidence: 90%

“…Especially patients with central diabetes insipidus (DI) or pre-existing hyponatraemia may be at risk of more severe, life threatening dysnatraemia. Regardless of pre-existing endocrine conditions, hyponatraemia is common in patients hospitalized with COVID-19 [2][3][4][5][6][7][8][9] and is associated with disease severity and mortality. This article is intended to advise how endocrinologists can still optimally care for ambulatory patients with central DI and hyponatraemia, where regular physical consultations and biochemical assessments are not possible.…”

Section: Introductionmentioning

confidence: 99%

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ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia

Hoorn

Sherlock

Thompson

et al. 2021

European Journal of Endocrinology

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COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatremia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20 to 30% and is mostly due to SIAD or hypovolemia. It mirrors disease severity and is an early predictor for mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3-5%, especially in ICU, and derives from different multifactorial reasons, e.g. due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

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Association of hypernatremia with mortality in patients with COVID‐19: A systematic review and meta‐analysis

Ma,

Zhang,

Hou

2023

Immunity Inflam & Disease

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BackgroundThe COVID‐19 pandemic worldwide has caused varying degrees of severity of lung damage in patients, with acute respiratory distress and death in severe cases. However, this is not directly caused by the virus itself, but by the production of inflammasome by monocytes in the body, leading to a systemic inflammatory response, which results in a very poor clinical prognosis for patients with COVID‐19.ObjectiveThe purpose of this meta‐analysis was to look at the relationship between hypernatremia and mortality in COVID‐19 patients.MethodsWe searched the PubMed, Web of Science, Embase, and Cochrane databases for articles published from the inception of the database until August 27, 2022. Three researchers reviewed the literature, retrieved data, and assessed the quality of the literature, respectively. A meta‐analysis was performed using State 17 software to assess the value of the effect of hypernatremia on mortality in patients with new coronavirus pneumonia.ResultsA total of nine publications was finally included in this study, including a total of 11,801 patients with COVID‐19, including 1278 in the hypernatremia group and 10,523 in the normonatremia group. Meta‐analysis showed that hypernatremia was associated with mortality in patients with COVID‐19 [OR = 4.15, 95% CI (2.95–5.84), p = .002, I² = 66.7%] with a sensitivity of 0.36 [0.26, 0.48] and a specificity of 0.88 [0.83, 0.91]. The posterior probability of mortality was 42% in patients with COVID‐19 hypernatremia and 15% in patients who did not have COVID‐19 hypernatremia.ConclusionAccording to available data, hypernatremia is associated with death in patients with COVID‐19.

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Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19

Cited by 41 publications

References 14 publications

COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia

Association of hypernatremia with mortality in patients with COVID‐19: A systematic review and meta‐analysis

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