Case Report

Neurogenic diabetes insipidus in a critical patient with COVID-19 pneumonia in treatment with extracorporeal membrane oxygenation: a case report

¹ Internal Medicine Residents, Department of Health Sciences, Christus Muguerza Health System, UDEM, 64060 Monterrey, Nuevo León, México
² Nephrology of the Critically Ill Patient, Internal Medicine, Internal Medicine Professor, Department of Health Sciences, Christus Muguerza Health System, UDEM, 64060 Monterrey, Nuevo León, México
³ Associate Professor of Nephrology Service, Hospital Universitario “José Eleuterio González”, UANL, 64460 Monterrey, Nuevo León, México
⁴ Infectious Diseases, Internal Medicine, Internal Medicine Assistant Professor, Department of Health Sciences, Christus Muguerza Health System, UDEM, 64060 Monterrey, Nuevo León, México
⁵ Pediatrics, Director of the ECMO Unit, Christus Muguerza Health System, UDEM, 64060 Monterrey, Nuevo León, México
⁶ Pulmonary and Critical Medicine, Internal Medicine Professor, Department of Health Sciences, Christus Muguerza Health System, UDEM, 64060 Monterrey, Nuevo León, México
⁷ Pulmonary and Critical Medicine Professor, Hospital Universitario “Dr. José Eleuterio González”, UANL, 64460 Monterrey, Nuevo León, México

^* Corresponding author: dra.liliarizo@gmail.com

Received: 27 August 2022
Accepted: 1 June 2023

Abstract

The following case report analyses a patient with extracorporeal membrane oxygenation (ECMO), who suffered from a severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 pneumonia. ARDS is defined as a diffuse and inflammatory injury of the lungs; classifying this as severe when the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO₂/FiO₂) is equal to or lower than 100 mmHg. To decide if the patient was suitable for the use of ECMO therapy, the ELSO criteria were used; and in this case, the patient matched with the criteria of hypoxemic respiratory failure (with a PaO₂/FiO₂ < 80 mmHg) after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. During hospitalization, the patient presented a Central Diabetes Insipidus (CDI), probably explained by the damage hypoxia generated on the central nervous system. There are few reports of this complication produced by COVID-19. The case is about a 39-year-old woman, who started with ECMO 6 days after the beginning of Invasive Mechanical Ventilation (IMV), because of a severe ARDS. On the fifth day of ECMO, the patient started with a polyuria of 7 L in 24 h. A series of paraclinical studies were made, but no evidence of central nervous system lesions was found. After treatment with desmopressin was initiated and the ARDS was solved, polyuria stopped; with this, CDI was diagnosed. There are many complications secondary to the evolution of COVID-19 infection, and some of them are not yet well explained.