Electrolyte and acid-base imbalance in severe COVID-19

Abstract

Acute systemic diseases, such as severe infections, can lead to electrolyte and acid-base alterations. To study the presence of electrolyte imbalance in severe COVID-19, we investigated the frequency and consequences of changes in electrolyte and acid-base patterns over time. We performed a retrospective cohort study including 406 patients with severe COVID-19. Levels of electrolytes, base excess, pH, serum osmolality and hematocrit, the first two weeks of hospitalization, were collected daily from the laboratory database and clinical data from patients’ medical records. We found that hyponatremia was present in 57% of the patients at admission and hypernatremia in 2%. However, within two weeks of hospitalization 42% of the patients developed hypernatremia, more frequently in critically ill patients. Lower levels of sodium and potassium at admission was associated with need of mechanical ventilation. Decreased pH at admission was associated with both death and need of mechanical ventilation. Hypernatremia in the ICU was combined with rising base excess and a higher pH. In the group without intensive care, potassium levels was significantly lower in the patients with severe hypernatremia. Presence of hypernatremia during the first two weeks of hospitalization was associated with 3.942 (95% CI 2.269–6.851) times higher odds of death. In summary, hypernatremia was common and associated with longer hospital stay and a higher risk of death, suggesting that the dynamics of sodium is an important indicator of severity in COVID-19.

Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia

“…This is in line with previous reports showing that dysnatremia (hypernatremia or hyponatremia) is a risk factor for mortality in patients with COVID-19 [ 30 , 31 ]. The dynamics of sodium are an important indicator of the severity of COVID-19, and dysnatremia is reportedly common and associated with a longer hospital stay and a higher risk of death [ 31 ]. We also identified hyperkalemia to be a risk factor for mortality.…”

“…Previous studies have found that both high and low [ 32 ] potassium levels are risk factors for mortality. In our study, acidosis was also observed to be a risk factor for death, which is similar to previous reports [ 31 , 32 ]. Other laboratory findings that were associated with mortality (anemia, leukocytosis, thrombocytopenia, high aPTT, high INR, high troponin, and high ferritin) have also been reported to be risk factors for death in patients with COVID-19 [ 33 , 34 ].…”

Determination of sodium and potassium ions in patients with SARS-Cov-2 disease by ion-selective electrodes based on polyelectrolyte complexes as a pseudo-liquid contact phase

“…It was discovered that hypernatremia is very common in severe COVID-19. 49 The increased incidence of hypernatremia seems to be associated with a significant water loss during the disease. 50 The results obtained indicated a correlation between micro and macro elements in the blood and urine of patients with coronavirus.…”

Elements and COVID-19: A Comprehensive Overview of Studies on Their Blood/Urinary Levels and Supplementation with an Update on Clinical Trials

“…As far as Na is concerned, Alkattan et al [ 157 ] did not observe any significant changes in the level of this element in the serum of severe versus non-severe COVID-19 patients, but other studies showed a significant reduction in the concentration of Na in the serum/plasma of patients with a severe form of COVID-19, in comparison with a group with mild disease [ 188 , 192 ] ( Table S2 ). Sjöström et al [ 193 ], who explored the dynamics of electrolytes in COVID-19 patients, revealed the presence of hyponatremia in subjects at admission followed by the development of hypernatremia during the first 2 weeks of hospitalization. As observed, hypernatremia was common and associated with a more severe COVID-19 course and a higher mortality rate.…”