Coronavirus Disease 2019 (COVID-19)-Induced Hyponatremia: A Challenging Geriatric Case

Abstract

Coronavirus disease 2019 (COVID-19) has presented numerous challenges to the medical community, including atypical complications such as electrolyte imbalances and organ dysfunction. This case report describes a 91-year-old female with a history of chronic medical conditions, including chronic kidney disease (CKD) stage 3, who presented with hypoxemic respiratory failure, transaminitis, and persistent hyponatremia during the course of her COVID-19 infection. Despite initial suspicion of the syndrome of inappropriate antidiuretic hormone secretion (SIADH), caused by elevated antidiuretic hormone (ADH), the patient's normal osmolality and sodium excretion suggested other contributing factors, such as poor oral intake (per os, PO), volume depletion, and pseudo-acute kidney injury (pseudo-AKI) leading to hypovolemic hyponatremia. Her transaminitis resolved with supportive care, allowing for the safe initiation of remdesivir. The patient's gradual correction of hyponatremia without complications highlights the importance of individualized management. This case highlights the varied and systemic effects of COVID-19, emphasizing the need for comprehensive care and monitoring of electrolyte disturbances during hospitalization.

Keywords: covid-19; electrolyte imbalance; geriatrics; hyponatremia; hypoxia; siadh; transaminitis.