Division of Endocrinology, Diabetes and Metabolism, 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. 2021 Aug 27;185(4):G35-G42. doi: 10.1530/EJE-21-0596.
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.
COVID-19 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 治疗中地美加压素的主要并发症是稀释性低钠血症。由于 COVID-19 期间并非总能监测血浆钠，因此我们建议延迟每周一次的地美加压素剂量，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。因血容量不足而住院的 COVID-19 并发 DI 患者死亡率高。专家必须监督液体替代和地美加压素的剂量。垂体手术后的患者应按需饮水，并每天测量体重，以尽早发现术后 SIAD 的发生。他们应了解低钠血症的症状。COVID-19 中低钠血症很常见，患病率为 20-30%，主要是由于 SIAD 或血容量不足引起。它反映了疾病的严重程度，是死亡率的早期预测指标。COVID-19 患者也可能出现高钠血症，患病率为 3-5%，尤其是在 ICU 中，源于多种不同的原因，例如，发热时不显性失水增加、呼吸频率加快和使用利尿剂。高钠血症性脱水可能导致 COVID-19 患者急性肾损伤风险增加。由于 COVID-19 患者发生肺水肿的风险，在严重的情况下应谨慎进行 IV 液替代治疗。
