Tolvaptan to Achieving High Urine Output and Avoiding Hyponatremia in COVID-19 with ADHF Patient: Case Report

Background: Pandemic of Coronavirus Disease 2019 (COVID-19) is a world health problem, with rapidly growing infected subjects. Recently, hyponatremia has been found to be associated with increased morbidity and mortality in hospitalized patients with severe acute respiratory syndrome-Coronavirus 2 (SARS-COV2) pneumonia. On the other hand, Acute heart failure (AHF) is a leading cause of hospitalization and readmission in the US. The standard management of AHF is removing the fluid primarily with loop diuretics or ultrafiltration. Unfortunately, the loop diuretics could lead to electrolyte imbalance. Case Description: A Male 71 years old with confirmed COVID-19 came to emergency room with shortness of breath and history of coronary artery disease (CAD). Unfortunately, the infection leads patient to non-ST Elevation Myocardial Infarction (NSTEMI). During the treatment, patient down to acute decompensated heart failure (ADHF). The congestion did not respond to Furosemide 40mg intravenously and Spironolactone 25mg orally. Discussion: Arginine‑vasopressin (AVP) levels are elevated in heart failure. AVP acts via V2 cause fluid retention and hyponatremia. Aquaretic (i.e., Tolvaptan) are antagonists of AVP-2 receptors in the renal tubules to promote solute-free water clearance and correct hyponatremia. Conclusion: Important to avoid hyponatremia to prevent mortality and sepsis in patient COVID-19.