ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES_ The management of diabetes insipidus and hyponatraemia.pdf (321.49 kB)
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Endocrinology in the time of COVID-19-2021 updates: the management of diabetes insipidus and hyponatraemia

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journal contribution
posted on 01.03.2022, 11:47 authored by Mirjam Christ-Crain, Ewout J Hoorn, Mark SherlockMark Sherlock, Christopher ThompsonChristopher Thompson, John Wass
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.



The original article is available at https://eje.bioscientifica.com/

Published Citation

Christ-Crain M, Hoorn EJ, Sherlock M, Thompson CJ, Wass J. Endocrinology in the time of COVID-19-2021 updates: the management of diabetes insipidus and hyponatraemia. Eur J Endocrinol. 2021;185(4):G35-G42

Publication Date

27 August 2021

PubMed ID



  • Beaumont Hospital
  • Medicine


BioScientifica Ltd.


  • Published Version (Version of Record)