01 May 2026
: Case report 
Unmasking Adrenal Insufficiency in COVID-19: The Diagnostic Challenge of Concomitant Acute Kidney Injury and High Ileostomy Output
Unusual clinical course, Challenging differential diagnosis
Ioanna I. Yglesias Dimadi
ABDEF 1*, Afshan Hussain E 1, Bronson Benno Joseph Raja AE 1
DOI: 10.12659/AJCR.952419
Am J Case Rep 2026; 27:e952419
Table 1 Key laboratory values on presentation to the emergency department.
| Laboratory test | Result | Normal range* | Interpretation |
|---|---|---|---|
| Creatinine | 10.5 mg/dL | 0.6–1.2 mg/dL | Acute kidney injury superimposed on chronic kidney disease |
| pH | <7.0 | 7.35–7.45 | Severe metabolic acidosis |
| Anion gap | 29.7 mEq/L | 8–16 mEq/L | Elevated, indicative of metabolic acidosis |
| Lactate | 1.5 mmol/L | 0.5–2.2 mmol/L | In normal range, but part of overall acidosis picture |
| Potassium | 7.1 mEq/L | 3.5–5.0 mEq/L | Hyperkalemia |
| Phosphorus | 10.8 mg/dL | 2.5–4.5 mg/dL | Elevated, often evident in kidney dysfunction |
| Sodium | 130 mEq/L | 135–145 mEq/L | Hyponatremia |
| Urinalysis (general) | Muddy brown casts, increases in white blood cells and squamous cells | Not applicable | Consistent with possible acute tubular necrosis |
| Fractional excretion of sodium | 0.3% | <1% | Suggestive of prerenal acute kidney injury |
| Fractional excretion of urea | 5.8% | 35–50% (prerenal acute kidney injury) | Low, suggesting prerenal etiology |
| Blood urea nitrogen | 94 mg/dL | 7–20 mg/dL | Elevated |
| * Normal ranges are based on chemistry laboratory service cutoff values at Jacobi Medical Center. | |||