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. 2020 May;57(3):262-265.
doi: 10.1177/0004563220922255. Epub 2020 May 3.

Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19)

Affiliations

Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19)

Giuseppe Lippi et al. Ann Clin Biochem. 2020 May.

Abstract

Background: Early studies have reported various electrolyte abnormalities at admission in patients who progress to the severe form of coronavirus disease 2019 (COVID-19). As electrolyte imbalance may not only impact patient care, but provide insight into the pathophysiology of COVID-19, we aimed to analyse all early data reported on electrolytes in COVID-19 patients with and without severe form.

Methods: An electronic search of Medline (PubMed interface), Scopus and Web of Science was performed for articles comparing electrolytes (sodium, potassium, chloride and calcium) between COVID-19 patients with and without severe disease. A pooled analysis was performed to estimate the weighted mean difference (WMD) with 95% confidence interval.

Results: Five studies with a total sample size of 1415 COVID-19 patients. Sodium was significantly lower in patients with severe COVID-19 (WMD: -0.91 mmol/L [95% CI: -1.33 to -0.50 mmol/L]). Similarly, potassium was also significantly lower in COVID-19 patients with severe disease (WMD: -0.12 mmol/L [95% CI: -0.18 to -0.07 mmol/L], I2=33%). For chloride, no statistical differences were observed between patients with severe and non-severe COVID-19 (WMD: 0.30 mmol/L [95% CI: -0.41 to 1.01 mmol/L]). For calcium, a statistically significant lower concentration was noted in patients with severe COVID-19 (WMD: -0.20 mmol/L [95% CI: -0.25 to -0.20 mmol/L]).

Conclusions: This pooled analysis confirms that COVID-19 severity is associated with lower serum concentrations of sodium, potassium and calcium. We recommend electrolytes be measured at initial presentation and serially monitored during hospitalization in order to establish timely and appropriate corrective actions.

Keywords: COVID-19; SARS-CoV-2; Sodium; calcium; chloride; coronavirus; potassium.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.
Forest plots comparing sodium, potassium, chloride and calcium concentrations between coronavirus disease 2019 (COVID-19) patients with or without severe disease. Individual weighted mean differences indicated by squares and 95% CI. Dashed vertical lines and diamonds indicate weighted mean difference, with diamonds further including the 95% CI. WMD: weighted mean difference.

Comment in

  • Covid-19 and hypokalaemia - A potential mechanism.
    Mandal AK, Kho J, Metaxa S, Missouris CG. Mandal AK, et al. Ann Clin Biochem. 2021 May;58(3):259-260. doi: 10.1177/0004563220973497. Epub 2020 Dec 1. Ann Clin Biochem. 2021. PMID: 33259724 No abstract available.

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