Elderly Covid patients prone to low sodium level: AIIMS study

Elderly Covid-19 patients, especially those with co-morbidities and showing signs of disorientation, need to be promptly hospitalised and checked for fall in sodium level, or it can prove fatal, according to a scientific research based on patients admitted at All India Institute Of Medical Sciences (AIIMS)-Patna

Elderly Covid-19 patients, especially those with co-morbidities and showing signs of disorientation, need to be promptly hospitalised and checked for fall in sodium level, or it can prove fatal, according to a scientific research based on patients admitted at All India Institute Of Medical Sciences (AIIMS)-Patna.

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Low sodium level or hyponatraemia, which is a common electrolyte abnormality in such patients, if unchecked, may lead to brain oedema and can be fatal, said Dr Utpal Anand, associate professor and head, department of gastrointestinal surgery at AIIMS-Patna.

Dr Anand has done a 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 said that existing medical literature suggests restriction of fluid corrects euvolemic hyponatremia, as low sodium level in Covid-19 is mainly due to Syndrome of Inappropriate Antidiuretic Hormone (SIADH), when excessive secretion of antidiuretic hormone due to stress in Covid-19 patients leads to fall in sodium level.

However, in his research, he found that SIADH is not the only cause of hyponatraemia.

“Hyponatraemia in Covid-19 can be multi-factorial, due to coexistent 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 hyponatraemia,” said Dr Anand.

He also found that roughly 14% of the elderly patients, above 60 years of age, sampled for the research suffered from hyponatraemia.

“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 hyponatraemia 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 added.

According to Dr Anand, in cases of alteration in behaviour or consciousness, infected elderly patients should urgently be hospitalised and their serum sodium should be promptly evaluated.