Abstract
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is one of the most common causes of hyponatremia in hospitalized patients. Wide spectrum of etiologies associated with hyponatremia pose significant challenges in detecting and treating this disorder. Several infectious causes of SIADH have been reported; however, hyponatremia associated with SIADH and Coronavirus disease 2019 (COVID-19) was only recently mentioned in a few case reports. We discuss a unique presentation of COVID-19, in which the patient presented with acute severe symptomatic hyponatremia thought to be the initial and isolated presentation of SARS-CoV-2 infection.
Highlights
Case reportThe syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by euvolemic hyponatremia, low plasma osmolality, high urinary osmolality, elevated natriuresis, hypouricemia, and lack of evidence of other hyponatremic diseases
We describe the case of a middle-aged gentleman with acute symptomatic hyponatremia and SIADH, attributed to COVID-19
After excluding other causes of SIADH in our case, we suggest that SARS-CoV-2 infection is the cause of SIADH with this presentation of acute severe hyponatremia
Summary
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by euvolemic hyponatremia, low plasma osmolality, high urinary osmolality, elevated natriuresis, hypouricemia, and lack of evidence of other hyponatremic diseases. A 57-year-old man, with past medical history significant for hypertension on amlodipine and type II diabetes on insulin glargine, presented to the emergency department with one day history of acute dizziness, most prominent with head movements and exacerbated with standing. It was associated with retrosternal burning pain especially after meals. The patient was transferred to a quarantine facility; he did not develop any respiratory symptoms or fever
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