Elderly Covid-19 patients, especially those with co-morbidity and showing signs of disorientation, need to be promptly hospitalised and checked for fall in sodium level. If left unchecked, it can be fatal, said a prominent surgeon.
Low sodium level or hyponatremia, which is a common electrolyte abnormality in such patients, if unchecked, may lead to brain oedema (fluid build up around brain) and can be fatal, says Dr Utpal Anand, associate professor and head, department of gastrointestinal surgery at the All India Institute of Medical Sciences (AIIMS), Patna.
Dr Anand has done scientific research based on case analysis of 500 elderly Covid-19 patients admitted at AIIMS, Patna. His finding, which forms a case series, has been recently accepted for publication in the Medical Journal Armed Forces India (MJAFI), a PubMed-indexed journal.
Dr Anand says that excessive secretion of antidiuretic hormone due to stress in Covid-19 patients leads to fall in sodium level, known as the Syndrome of Inappropriate Antidiuretic Hormone (SIADH), causing hyponatremia in Covid-19 patients. His research found that SIADH is not the only cause of hyponatremia.
“Hyponatremia in Covid-19 can be multifactorial, due to co-existent abnormalities like diabetes and hypocortisolism, a disorder in which the adrenal glands don’t produce enough hormones. Associated pneumonia, respiratory failure and stress in patients with coronavirus can also lead to hyponatremia,” says Dr Anand.”
He also found that roughly 14% of the elderly patients, above 60 years of age, sampled for the research, suffered from hyponatremia. So, if the elderly under home isolation with mild Covid-19 infection demonstrate any alteration in behaviour or consciousness, Dr Anand advises urgent hospitalisation and prompt evaluation of their serum sodium.
“A proper clinical evaluation and interpretation of laboratory parameters like urine osmolality, plasma osmolality, cortisone level, thyroid hormone level, sugar level and lipid profile are important in management of hyponatremia associated with Covid-19. This will help to identify multiple contributing factors so that a targeted treatment strategy can be instituted in order to avoid serious consequences,” he adds.