Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eur J Endocrinol. 2020 Jul;183(1):G9-G15. doi: 10.1530/EJE-20-0338.
COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, 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 the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, 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.
新型冠状病毒肺炎改变了医疗咨询的性质，强调虚拟患者咨询，这与尿崩症（DI）或低钠血症患者有关。DI 患者使用去氨加压素治疗的主要并发症是稀释性低钠血症。由于在新型冠状病毒肺炎期间并非总能监测血浆钠，因此我们建议每周延迟一次去氨加压素剂量，直到出现尿崩症，从而排出多余的潴留水。患者应每天测量体重。因新型冠状病毒肺炎住院的 DI 患者由于血容量不足而有很高的死亡率风险。专家必须监督液体替代和去氨加压素的剂量。垂体手术后的患者应按需饮水，并每天测量体重，以便及早发现术后抗利尿激素不适当分泌综合征（SIAD）的发展。他们应该了解低钠血症的症状。因新型冠状病毒肺炎导致肺炎的患者中低钠血症的患病率尚不清楚，但似乎较低。相比之下，由于发热导致不显性失水、呼吸频率增加和使用利尿剂，重症监护病房（ICU）的新型冠状病毒肺炎患者可能会出现高钠血症。由于肺水肿的风险，在重症新型冠状病毒肺炎患者中应谨慎给予静脉补液。
