Endocrine Abstracts

Introduction

Hyponatremia secondary to the syndrome of inappropriate anti diuretic hormone (SIADH) secretion is one of the most frequently observed electrolyte abnormalities in coronavirus disease -2019 (COVID-19). Herein, we report a new case of SIADH in a type 2 diabetic patient with COVID-19 pneumonia.

Observation

A 79-year-old man with type 2 diabetes mellitus was admitted for a poor general condition. On physical examination, he had a tachycardia and alveolar sounds. No other abnormalities were found. On biological investigations, he had a blood glucose level of 15 mmol/l, a serum sodium of 122 mmol/l, a potassium level of 4.1 mmol/l, a serum urea level of 0.17 g/l, a serum creatinine level of 7 mg/l, a C-reactive protein (CRP) of 53 mg/l, white blood cells of 3380 elements/mm³, and lymphocytes of 660 elements/mm³. Corrected natremia was 124.7 mmol/l and the plasmatic osmolarity was 270 mOsmol/l. Chest computed tomography-scan revealed a suggestive aspect of a moderate COVID-19 pneumonia. RT-PCR nasopharyngeal swab test was positive. The diagnosis of SIADH was established and the patient was put on a fluid restriction. The outcome was marked by the elevation of the natremia reaching 133 mmol/l.

Conclusion

Hyponatremia due to SIADH was reported in patients with COVID-19 infection. Its pathophysiological mechanism involves many factors associated with infection such as cytokine storm, stress, and pain. However, it is important to rule out other etiologies of hyponatremia in order to ensure the appropriate management.