Hypokalemia and Clinical Implications in Patients with Coronavirus Disease 2019 (COVID-19)

Abstract

medRxiv preprint BACKGROUND SARS-CoV-2 has caused a series of COVID-19 globally. SARS-CoV-2 binds angiotensin I converting enzyme 2 (ACE2) of renin-angiotensin system (RAS) and causes prevalent hypokalemia METHODSThe patients with COVID-19 were classified into severe hypokalemia, hypokalemia, and normokalemia group. The study aimed to determine the relationship between hypokalemia and clinical features, the underlying causes and clinical implications of hypokalemia. RESULTS ByFeb 15, 2020, 175 patients with COVID-19 (92 women and 83 men; median age, 46 [IQR, 34-54] years) were admitted to hospital in Wenzhou, China, consisting 39 severe hypokalemia-, 69 hypokalemia-, and 67 normokalemia patients.Gastrointestinal symptoms were not associated with hypokalemia among 108 hypokalemia patients (P>0.05). Body temperature, CK, CK-MB, LDH, and CRP were significantly associated with the severity of hypokalemia (P<0.01). 93% of severe and critically ill patients had hypokalemia which was most common among elevated CK, CK-MB, LDH, and CRP. Urine K + loss was the primary cause of hypokalemia. 1 severe hypokalemia patients was given 3 g/day, adding up to an average of 34 (SD=4) g potassium during hospital stay. The exciting finding was that patients responded well to K + supplements when they were inclined to recovery.

Renin-angiotensin-aldosterone system and COVID-19 infection

“…Thus, the level of ACE2 membrane expression and/or tissue activity may influence onset of COVID-19 infection and thus the risk of developing more severe inflammatory tissue injuries. Likewise, in a recent retrospective study of 175 Chinese COVD-19 patients requiring hospital admission, 62% showed hypokalemia, which the authors explained by altered angiotensin II deactivation by a shift in ACE1/ACE2 balance (reduced ACE2 tissue activity under COVID-19) in favor of ACE1, thus inducing aldosterone synthesis and hypokalemia occurrence (27) (Figure 1). If this hypothesis is confirmed, mineralocorticoid receptor blockers may be able to contribute to correcting this hypokalemia.…”

Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study

“…Laboratory examinations included routine testing, analysis of immuno logical responses, and measurement of bio markers for monitoring lung, liver, myocardial, and renal functions. We compared the prevalence of abnormal clinical indices of the paediatric patients with previously reported data for 175 adults with COVID-19 in Wenzhou, 17 44 paediatric patients with SARS in Hong Kong, 10,18 and 167 Chinese paediatric patients with H1N1 influenza. 19…”

Cardiovascular disease and COVID-19

“…in patients with underlying cardiac disorder. There is particular concern about hypokalemia in COVID-19, due to interaction of SARS-CoV-2 with renin-angiotensin-aldosterone system [7]. Hypokalemia increases vulnerability to various tachyarrhythmias.…”