Abstract
COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. 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 20–30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3–5%, especially in ICU, and derives from different multifactorial reasons, for example, 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.
Highlights
This is an update of the previously published guidelines 1 year ago [1]
Patients with pre-existing endocrine conditions may be vulnerable to perturbations in plasma sodium in more severe cases of COVID-19
Patients with central diabetes insipidus (DI) or pre-existing hyponatraemia may be at risk of more severe, life-threatening dysnatraemia
Summary
Mirjam Christ-Crain, Ewout J Hoorn, Mark Sherlock, Chris J Thompson and John Wass. Mirjam Christ-Crain, Ewout J Hoorn, Mark Sherlock, Chris J Thompson and John Wass4 This manuscript is part of a commissioned series of urgent clinical guidance documents on the management of endocrine conditions in the time of COVID-19. This clinical guidance document underwent expedited open peer review by Joe Verbalis (USA), Jens Otto Jørgensen (Denmark), Stefan Bilz (Switzerland) and Georg Lindner (Switzerland)
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