Endocrine Abstracts

Background: Following the RECOVERY study, dexamethasone is prescribed for patients requiring inpatient treatment of Covid. Cases of new and atypical diabetes have been reported during this pandemic. The risk of steroid induced hyperglycaemia is well recognised but other metabolic sequelae less so. We present a patient who developed severe hypernatraemia following commencement of dexamethasone.

Case Report: A 44-year-old man (unvaccinated) was diagnosed with Covid-19 infection a week prior to hospital admission. Shortly after his Covid-19 diagnosis, he developed weakness, breathlessness and polyuria which deteriorated until he presented on day 7 to the ED. He was diagnosed with new T1DM and severe DKA (pH 6.9). Dexamethasone 6 mg was commenced despite no evidence of pneumonitis. He received 5 litres of intravenous 0.9% saline on day 1 of admission and about 3 litres on subsequent days. His serum Na rose to 156 mmol/l by day 3 so fluids were changed to Hartmann’s and subsequently to 5% Dextrose yet the Na level rose to 162 mmol/l by day 5. Hypokalaemia (2.6 mmol/l) was also noted. The Endocrine team advised that Dexamethasone stopped as the patient was not requiring supplementary oxygen. Afterwards, the Na level progressively improved and normalised on the 4th day.

Conclusion: Steroids can cause hypernatraemia by enhancing water excretion and exhibiting mineralocorticoid effects. Resistant hypernatraemia should be recognised as a side effect of high dose steroids, and when identified a risk-benefit analysis regarding continuation of steroids conducted. Caution is advised in prescribing dexamethasone in patients with Covid and diabetes.