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. 2022 Aug 21;14(16):3439. doi: 10.3390/nu14163439

Table 1.

A summary of the most important ions imbalance during COVID-19 and their effects on CV system.

Ion Relationship among CV Diseases and Ions Relationship among
COVID-19 and Ions		 Reference
Sodium (Na+)

  1. Sodium imbalance is the most common electrolyte disorder

  2. Sodium imbalance affects blood volume, blood pressure, osmotic and acid-base equilibrium regulation

  1. Dysnatremia is an independent risk factor for mortality in hospitalized patients, including COVID-19 patients

  2. Hyponatremia is associated with increased risk of encephalopathy and mechanical ventilation necessity

 [38,40]
Magnesium (Mg++)

  1. Magnesium deficiency is associated with increased incidence of arrhythmias, arterial hypertension and atherosclerosis

  1. Hypomagnesaemia has been associated with more severe COVID-19 cases

 [63,64]
Potassium (K+)

  1. Alterations in potassium levels predispose to cardiac arrhythmias

  2. Potassium imbalance leads to derangements in vascular tone and systemic blood pressure regulation

  1. High incidence of potassium imbalance has been found in COVID-19 patients

  2. Hypokalemia is the most common disorder, and it is associated with worse prognosis

  3. Hyperkalemia occurs less frequently than hypokalemia

 [84,89]
Calcium (Ca++)

  1. Hypocalcemia is associated with derangements in coagulation and platelet adhesion

  2. Hypocalcemia affects myocardial contractility and relaxation

  1. COVID-19 patients have lower calcium levels compared to patients without COVID-19

 [106,114,115]
Iron (Fe++/Fe+++)

  1. Iron deficiency and anemia are frequent comorbidities in CV diseases

  2. In HF anemia and iron deficiency represent an independent condition predisposing to CV and overall mortality, rehospitalization and quality of life and symptoms worsening

  1. Significantly lower levels of hemoglobin have been found in COVID-19 patients admitted to ICU compared to those who were not admitted to ICU

  2. Iron deficiency is crucial in depressing immune response

 [128,129,130,131,133]
Zinc (Zn++)

  1. Zinc deficiency causes oxidative stress, laying the groundwork for atherosclerosis.

  2. Zinc deficiency can reduce cardiac inotropism.

  1. Zinc supplementation can promote the restoration of ACE2 expression in COVID-19 patients.

 [158,159]

COVID-19: coronavirus disease 2019; CV: cardiovascular; ICU: intensive care unit; HF: heart failure; ACE2: angiotensin-converting enzyme 2.