COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

Abstract

Objective: To investigate the occurrence of disorders of water and sodium balance in COVID-19 in our clinic. Methods: In this retrospective chart review, patients were included if a polymerase chain test result for SARS-CoV-2 was obtained and if at least one plasma sodium concentration measurement was obtained during the period from March to June 2020. The occurrences of hyponatremia and hypernatremia were compared between 193 SARS-CoV-2-positive and 138 SARS-CoV-2-negative patients. A χ² test was used to determine statistical significance, and the corresponding p-values were calculated. Results: Hypernatremia was significantly more frequently observed in COVID-19 patients, in 38% (74 of 193), versus only 8% in SARS-CoV-2-negative patients (11 of 138) ( p < 0.01). Hyponatremia was observed in 34% of the included COVID-19 patients (65 of 193) versus 24% of SARS-CoV-2-negative patients (33 of 138). In 12% of all COVID-19 patients (23 of 193), both hyponatremia and hypernatremia were observed at some point during their admission. Among the non-COVID-19 patients, only 4% showed these plasma sodium concentration fluctuations (5 of 138). The mortality rate among the hospitalized COVID-19 patients was 23% (45 of 193). Correcting for double-counting, more than 71% (32 of 45) of the deceased COVID-19 patients developed dysnatremia (hyponatremia, hypernatremia or both) versus 57% (84 out of 148) of the surviving COVID-19 patients. Conclusion: Disorders of water and sodium balance—and especially hypernatremia—seem to be a common occurrence in COVID-19 patients. This has important implications for the treatment of COVID-19 patients.

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

“…[34,41,42] On the contrary, admission hypernatraemia or the development of hypernatraemia during hospitalisation have been associated with increased mortality and death. [30,35,36,39,40] Similarly, we found a correlation between hypernatraemia and a long hospital stay. It has been reported that SARS-CoV-2 binds to the angiotensin-converting enzyme 2 receptor in kidney tubules.…”

“…Dysnatraemia in COVID-19 hospitalised patients has generally been associated with poorer outcomes. [30][31][32][33][34][35][36][37][38][39][40][41][42] Both hypernatraemia and hyponatraemia, at admission, have been associated with increased mortality, ICU admission, longer hospitalisation and mechanical ventilation. [32,37,38] Specifically, hyponatraemia was found to be relatively common in hospitalised COVID-19 patients and to be associated with severe illness and increased in-hospital mortality.…”

Baseline electrolyte disorders predict disease severity and mortality in patients with COVID-19

“…[22] Disnatremia was observed more frequently in COVID-19 patients than in other patients. [23] Abnormalities in serum sodium, calcium, and potassium levels at admission were found at 20.6%, 14%, and 4.2%, respectively in our study. While hyponatremia was the most prevalent electrolyte disorder in this study and observed in 60% of hospitalized patients, hypernatremia was observed in only 2.2% of this group.…”

Pituitary and COVID-19: review

“…Гипонатриемия наблюдалась у 34% включенных пациентов с COVID-19 (65 из 193) по сравнению с 24% пациентов с отрицательным результатом на SARS-CoV-2 (33 из 138). У 12% всех пациентов с COVID-19 (23 из 193) в ходе госпитализации наблюдались как гипонатриемия, так и гипернатриемия [64].…”