Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

Toklu, Hale; Ganti, Latha; Crimi, Ettore; Cintron, Cristobal; Hagan, Joshua; Serrano, Enrique

doi:10.1186/s12245-020-00327-4

International Journal of Emergency Medicine

Table 3 The clinical profile of patients who had a CSF analysis. N = 8

From: Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

Hypernatremia								Normal sodium
		*Case 1*	*Case 2*	*Case 3*	*Case 4*	*Case 5*	*Case 6*	*Case 7*	*Case 8*
Demographics	Age (years)	79	66	76	77	58	82	64	64
	Sex	M	M	M	M	M	M	M	M
	Race	White	Asian	Asian	White	White	White	White	White
Serum (highest)	White blood cell count (#/ul)	10.0	23.1	31.4	13.63	19.8	10.3	45.9	18.2
	Hemoglobin (g/dl)	14.9	15.2	13.4	16.7	14	11.7	14.7	12.6
	D-dimer (mg/L FEU)	3.768	31.04		1.62		2.60	36.39
	Alanine aminotransferase (IU/L)	34	54	157	95	164	75	93	36
	Aspartate aminotransferase (IU/L)	99	65	122	91	226	62	91	77
	Creatinine (mg/dL)	1.21	1.18	7.27	2.61	2.85	1.41	7.82	10.60
	Troponin I (ng/mL)	0.036	< 0.020	0.210	0.018	0.352	0.150	1.110	0.238
	Sodium (mEq/L)	163	152	146	156	150	163	142	145
	Hypernatremia severity • Mild (146-150 mEq/L • Moderate (151-154 mEq/L) • Severe (≥ 155 mEq/L)	Severe	Moderate	Mild	Severe	Mild	Severe	None	None
Vitals (admission)	SpO₂ (%)	?	89	93	91	90	92	93	88
	Temperature (F)	?	98.1	100.4	97.5	98.3	97.9	102.7	101.4
	Pulse (beats/min)	?	105	107	71	97	97	146	74
	Blood pressure (mmHg)	?	142/69	132/66	139/68	113/55	128/76	133/95	183/69
Arrival mode to Emergency Department			Walk-in	Ambulance			Ambulance	Walk-in	Walk-in
Cerebrospinal Fluid (CSF) analysis	White blood cell count (#/ul)	Normal	Normal	Normal	High	Normal	Normal	Normal	High
	Total cell count (#/ul)	Normal	Normal	High	High	Normal	Normal	Normal	High
	Total protein (mg/dl)	High	High	Normal	High	Normal	Normal	High	High
	Glucose (mg/dl)	High	Normal	High	High	High	High	High	High
	IgG		Normal		High
	Neuron specific enolase (NSE)				High
	Lactate dehydrogenase (LDH)		Normal	Normal
Clinical outcome	Neurological symptoms		Myoclonus, metabolic encephalopathy, unspecified convulsions, anorexia	Metabolic encephalopathy, encephalitis and encephalomyelitis, unspecified convulsions	Nausea, seizures, encephalopathy		Cerebral infarction, quadriplegia, unspecified, febrile convulsions, dysphagia		Metabolic encephalopathy, absence epileptic syndrome, intractable, with status epilepticus
	Other diagnosis		Sepsis, ARDS, hypertension, benign prostate hypertrophy	Sepsis, ARDS, cardiac arrest, acute kidney failure, type 2 DM	Sepsis, ARDS, acute kidney failure, acute liver failure		Sepsis, ARDS, type 2 DM, diabetic neuropathy, nephropathy, acute diastolic heart failure	ARDS, Morbid obese, type 2 DM, HT	ARDS, type 2 DM, HL, cardiac arrest
	Disease severity	Severe/critical	Severe/critical	Severe/critical	Severe/critical	Severe/critical	Severe/critical	Severe/critical	Severe/critical
	Ventilator need	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
	Ventilator time	?	28 days	25 days	17 days	27 days	16	11	5
	Length of stay in hospital	26	41	45	20	39	20	31	17
	In-hospital mortality	Ex	Ex	Ex	Ex	Discharged	Ex	Discharged	Ex

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