• COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatremia.
• The principles of management outlined in international guidelines still form the basis of management during COVID-19.
• 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. Endocrinologists must supervise the fluid replacement and dosing of desmopressin.
• Patients after pituitary surgery should only drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms.
• Hyponatraemia is common in patients with pneumonia, but it is unclear if it is only a marker of disease severity or if its correction improves outcomes. Its prevalence 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 most probably due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high rate 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
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