Hypokalemia in Patients with COVID-19

Journal of Advances in Medicine and Medical Research

Objectives: This study was designed to evaluate the prevalence, and the severity of hypokalemia, and the factors associated with hypokalemia among patients hospitalized with COVID-19. Methods: Random sampling technique was employed in this study. Socio-demographic data such as age, gender, weight (kg), height (meters) and BMI (kg/m2) as well as presenting symptoms (pulmonary and extra-pulmonary), duration of admission, the need for mechanical ventilation and treatment outcomes (discharged or died) as well as the plasma level of potassium (mmol/l) were extracted from the medical records of RT-PCR confirmed hospitalized cases of COVID-19 patients. Data collected were analyzed with IBM/ SPSS version 25.0 software. Discrete variables were presented as percentages and frequencies and the associations between qualitative variables tested using the Chi-square test at a level of significance of p < 0.05. Results: Hypokalaemia was detected in 61 out of 117 COVID-19 positive subjects used ...

Journal of Dhaka Medical College, 2021

Importance: Hypokalemia is a neglected common manifestation in COVID-19 patients admitted in hospital though it has serious consequences. Coronavirus may cause hypokalemia through disruptions of rennin-angiotensin system, gastrointestinal loss or other unknown mechanisms. Objective: To investigate the prevalence of hypokalemia among patients with moderate to severe COVID-19 and its association with other clinical and laboratory parameters. Design, Setting, and Participants: This was cross sectional observational study conducted at Dhaka medical College Hospital of Bangladesh from June, 2020, to August 2020. Participants were included who were positive for rt-PCR for COVID-19 according to the national guideline. The patients were classified as having severe hypokalemia (plasma potassium <3 mmol/L), hypokalemia (plasma potassium 3-3.5 mmol/L), and normokalemia (plasma potassium >3.5 mmol/L). Results: Prevalence of hypokalemia among patients with COVID-19 was 20.2%, severe hypoka...

Internal and Emergency Medicine

In patients visiting the emergency department (ED), a potential association between electrolytes disturbance and coronavirus disease 2019 (COVID-19) has not been well studied. We aim to describe electrolyte disturbance and explore risk factors for COVID-19 infection in patients visiting the ED. We carried out a case-control study in three hospitals in France, including adult ED inpatients (≥ 18 years old). A total of 594 ED case patients in whom infection with COVID-19 was confirmed, were matched to 594 non-COVID-19 ED patients (controls) from the same period, according to sex and age. Hyponatremia was defined by a sodium of less than 135 mmol/L (reference range 135-145 mmol/L), hypokalemia by a potassium of less than 3.5 mmol/L (reference range 3.5-5.0 mmol/L), and hypochloremia by a chloride of less than 95 mmol/L (reference range 98-108 mmol/L). Among both case patients and controls, the median (IQR) age was 65 years (IQR 51-76), and 44% were women. Hyponatremia was more common among case patients than among controls, as was hypokalemia and hypochloremia. Based on the results of the multivariate logistic regression, hyponatremia, and hypokalemia were associated with COVID-19 among case patients overall, with an adjusted odds ratio of 1.89 [95% CI 1.24-2.89] for hyponatremia and 1.76 [95% CI 1.20-2.60] for hypokalemia. Hyponatremia and hypokalemia are independently associated with COVID-19 infection in adults visiting the ED, and could act as surrogate biomarkers for the emergency physician in suspected COVID-19 patients.

Cukurova Medical Journal

Purpose: We investigated the effects of hypokalemia on clinical outcomes in hospitalized patients with Covid-19 pneumonia. Materials and Methods: In this single-center retrospective study, we recorded characteristics of hospitalized covid-19 pneumonia patients and laboratory test results on the first hospital day. Duration of hospitalization, requiring intensive care including mechanical ventilation and survival, were determined. Results: Our study included 185 patients and of them 111 male (60% male) patients with mean age of 64 ± 14.5 (23-90). Patients were grouped as hypokalemic (16.8%) and normokalemic patients (83.2%). The number of diabetic patients was higher in the normokalemic group. Serum total protein and albumin levels were lower in hypokalemic group, while alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, direct bilirubin, blood pH and bicarbonate level were higher. In multiple logistic regression analyses, alkalosis increased risk of hypokalemia 5.7...

Journal of Nephrology

Biomedical Sciences

Background: Disorders of electrolytes balance, especially that of potassium, have frequently been documented among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, most of these reports have been documented among the western populations. Hence, this current study was aimed to evaluate the pattern of derangement in potassium balance and its correlation to other clinical and laboratory variables among Nigerians. Methods: Archived data of all eligible adult patients, who were managed at the Eleme treatment center in Port Harcourt, Nigeria following a positive real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection, were enrolled for this study. All relevant data of enrolled subjects were retrieved from the archived case notes, medical review charts, nurses' charts, and laboratory-related records at initial presentation before any form of medical treatment by trained research assistants using well-structured data extraction forms. The collected data was analyzed using descriptive and comparative statistics. Results: Hypokalemia was recorded in 323 (62.8%) subjects out of a total of 515 eligible subjects. Mild, moderate, and severe hypokalemia was recorded among 32 (9.9%), 219 (67.9%), and 72 (22.2%) subjects, respectively. The subjects with severe hypokalemic status were mostly males and also of older age and had significantly higher systolic blood pressure, CRP, D-dimer, neutrophil count, and higher proportions of those with severe SARS-CoV-2 infection but lower albumin levels, lymphocyte and platelet counts compared to those with mild and moderate hypokalemic status (p<0.05). Inverse relationships were established between plasma potassium status and systolic blood pressure, sodium, C-reactive protein, D-dimer, and neutrophil count. While a significant positive relationship was observed between plasma potassium status and plasma albumin, lymphocyte counts, platelet counts, and oxygen saturation among the hypokalemic subjects (p<0.05). Compare to mild and moderate hypokalemic status, severe hypokalemic status was associated with severe SARS-CoV-2 infection (OR: 5.671; (95%CI: 4.467-7.365); p<0.001) and unfavorable clinical outcomes (OR: 7.863; (95%CI: 6.502-9.342); p<0.001) among the hypokalemic subjects. Conclusion: The present study findings suggest a high frequency of hypokalemia among subjects with the SARS-CoV-2 infection who are mostly males and of older age. The observed hypokalemia, especially the severe variant, was found in association with the severe infection and unfavorable clinical outcome. These findings should be considered during the management of SARS-CoV-2 infection. However, further studies are recommended to verify the conclusions of the present study.

PLOS ONE, 2020

Background Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. Aims This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. Methods Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete selfmedication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. Results A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L

Clinical Medicine, 2015

The relationship between serum potassium levels and mortality in acute medical admissions is uncertain. In particular, the relevance of minor abnormalities in potassium level or variations within the normal range remains to be determined. We performed a retrospective cohort study of all emergency medical admissions to St James's Hospital (Dublin, Ireland) between 2002 and 2012. We used a stepwise logistic regression model to predict in-hospital mortality, adjusting risk estimates for major predictor variables. There were 67,585 admissions in 37,828 patients over 11 years. After removing long-stay patients, 60,864 admissions in 35,168 patients were included in the study. Hypokalaemia was present in 14.5% and hyperkalaemia in 4.9%. In-hospital mortality was 3.9, 5.0, and 18.1% in the normokalaemic, hypokalaemic and hyperkalaemic groups respectively. Hypokalaemic patients had a univariate odds ratio (OR) of 1.29 for in-hospital mortality (95% confidence interval (CI) 1.16-1.43; p<0.001). Hyperkalaemic patients had a univariate OR for in-hospital mortality of 5.2 (95% CI 4.7-5.7; p<0.001). The ORs for an in-hospital death for potassium between 4.3 and 4.7 mmol/l, and 4.7 and 5.2 mmol/l, were 1.73 (95% CI 1.51-1.99) and 2.97 (95% CI 2.53-3.50) respectively. Hyperkalaemia and hypokalaemia are associated with increased mortality.

Background: Hypokalemia, one of the most common electrolyte disturbances, is diagnosed if plasma potassium concentration is <3.5 mmol/L. The present study was carried out with an objective to know the varied presentation of hypokalemia, its contributing factors, and clinical outcome after potassium replacement therapy. Method: Total 50 patientswho presented with hypokalemia (serum potassium level <3.5 mmol/L) were enrolled during a study period of April 2019 to June 2019.A detailed history was taken. All relevant investigations including complete blood count, urea, creatinine, sodium, potassium, thyroid function test, serum magnesium, ultrasound and ECG were done. Results:Among 50 patients, 45 (90%) were recovered completely with potassium correction and 5 (10%) died because of respiratory failure. On investigation, serum K+ was low in 5 (10%) patients of which 4 recovered and all these patients had ST-T flattening, U waves and prolonged QT interval. ST-T flattening was present in a majority of 64% patients and all were recovered. 14 (28%) patients had associated hyponatremia (<130 mmol/l) of which 2 patients expired whereas 33 (66%) patients had normal Na+ levels of which 3 patients expired. 88% of patients turned to have chronic kidney disease evidenced by elevated urea, creatinine and small kidney sizes with loss of CMD in ultrasonography. 30 patients were alcoholics and which confirms that alcohol causes kaliuresis, promotes increased K+ rentry into the cells. Concomitant magnesium deficiency aggravates hypokalemia which was noted in 7 patients.Conclusion:A careful history, physical, and systematic approach can identify the aetiology of most hypokalemia. A thorough search for aetiology should be undertaken to prevent repeated attacks of this potentially life-threatening dyselectrolytemia.

Health Science Reports, 2022

Background: The purpose of the study was to measure the prevalence of hyponatremia and its association with clinical and laboratory characteristics of hospitalized coronavirus disease 2019 (COVID-19) patients at Dhaka Medical College and Hospital (DMCH). Methods: This retrospective study was conducted in COVID-19 dedicated wards at DMCH from June to August 2020. Demographic, clinical, and laboratory data were collected from patient treatment sheets. Two groups of COVID-19 patients were retrospectively screened on the basis of plasma sodium level at admission: hyponatremic (sodium < 135 mM, n = 84) or normonatremic (sodium ≥ 135 mM, n = 48) patients. Severity was assessed using World Health Organization classification for COVID-19 disease severity. To compare the two groups, Pearson's χ 2 (qualitative variables) and Student's T tests (quantitative variables) were applied. The link between patients' clinical data and outcomes was investigated using logistic regression model. Results: A total of 132 patients were included in the study, with a mean age of 51.41 (±14.13) years. Hyponatremia was found in 84 patients (63.6%) and the remaining 48 patients (36.4%) had normal plasma Na + values. Among them, 74 (56.06%) presented with severe disease and 53 (40.15%) with moderate disease. At presentation, patients with moderate COVID-19 disease had 2.15 (1.04-4.5) times higher odds of suffering from hyponatremia. Besides, hyponatremia was independently associated with on admission SpO 2 (p = 0.038), hemoglobin (p = 0.004), and C-reactive protein (p = 0.001). Conclusions: The authors suggest that patients' serum electrolytes be measured during initial hospital admission and then monitored throughout the hospital stay to predict the probability for referral for invasive ventilation and for better management.