Introduction
Currently, the COVID-19 pandemic is challenging the healthcare system of more than 200 countries. Earlier pool analyses suggested that electrolyte abnormalities can be a common finding in Covid-19 patients that can be an obstacle in managing these patients. Herein, we investigated the prevalence of electrolyte imbalances in 300 hospitalized patients due to COVID-19 to broaden our understanding of the underlying cause of electrolyte disturbances in these patients.
Methods
Using randomized sampling, we selected hospitalized 300 patients due to COVID-19 in Baqiattollah hospital in Tehran and investigated their medical records for electrolyte abnormalities. Of 300 patients, 159 patients (53%) were male, and 141 patients (47%) were female with an average age of 58.2 (SD: 14.2, min =19 max =99). Furthermore, among 300 patients, 132 patients (44%) experienced severe forms of COVID-19 and were admitted to the Intensive care unit (ICU) according to hospital guidelines. Patients with a previous history of chronic kidney disease or other forms of renal or endocrine disorders that can interfere with normal electrolyte concentrations were excluded from this study.
Results
As demonstrated in Table 1, the most common electrolyte imbalance observed in patients was hyponatremia (42 %), followed by hypomagnesemia (35 %). It was observed that the number of patients who experienced hyponatremia or hypomagnesemia was significantly higher in ICU-admitted patients. The prevalence of hypernatremia was not as high as hyponatremia, but the prevalence of this electrolyte disturbance was significantly higher in ICU patients. Moreover, although 10 % of patients experienced hypokalemia, there was no significant difference between severe cases and mild to moderate patients. In contrast, it was observed that hyperkalemia was significantly higher among ICU-admitted patients. Finally, hypocalcemia, hypercalcemia, and hypermagnesemia were not a common finding in the patients of this study to come up with a conclusion regarding their prevalence. Furthermore, as demonstrated in Table 2, it was observed that the sodium, magnesium, and calcium concentrations were significantly lower in patients admitted to ICU. Also, there was no significant difference between males and females regarding electrolyte abnormalities.
Conclusions
In summary, we concluded that electrolyte abnormalities, especially hyponatremia and hypomagnesemia are common findings in COVID-19 patients and are more common in severe cases. These results confirm the importance of considering electrolyte imbalances in managing COVID-19 patients. Several potential causes can contribute to hyponatremia in COVID-19 patients, including Syndrome of inappropriate antidiuretic hormone secretion (SIADH), excessive fluid replacement therapies, and side effects of medications. Hypomagnesemia, a common finding in patients admitted to ICU, can be explained by similar reasons. Another potential mechanism for hypomagnesemia and hyponatremia is tubular injury since SARS-CoV-2 particles were isolated from podocytes of proximal tubule which contributes to Na and Mg reabsorption. Other electrolyte abnormalities can be the results of improper fluid therapy, a Side effect of medications, kidney failure, dialysis during hospitalization, or organ failure. Further studies in this area must be conducted.
No conflict of interest