Hypokalemia in Patients with COVID-19

Alfano, Gaetano; Ferrari, Annachiara; Fontana, Francesco; Perrone, Rossella; Mori, Giacomo; Ascione, Elisabetta; Magistroni, Riccardo; Venturi, Giulia; Pederzoli, Simone; Margiotta, Gianluca; Romeo, Marilina; Piccinini, Francesca; Franceschi, Giacomo; Volpi, Sara; Faltoni, Matteo; Ciusa, Giacomo; Bacca, Erica; Tutone, Marco; Raimondi, Alessandro; Menozzi, Marianna; Franceschini, Erica; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Gaetano, Margherita Di; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Milić, Jovana; Meschiari, Marianna; Mussini, Cristina; Cappelli, Gianni; Guaraldi, Giovanni

doi:10.1007/s10157-020-01996-4

Cited by 90 publications

(112 citation statements)

References 25 publications

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“…However, the plasma concentration of Ang II in COVID-19 patients is probably too high so that its harmful effects are not offset by the protective action of Ang-(1-7). As previously reported (95), it is also likely that the high plasma concentration of Ang II triggers overproduction of aldosterone through AT1 receptor stimulation, which may be at least in part responsible of the hypokaliemia observed in some COVID-19 patients.…”

Section: Discussionmentioning

confidence: 55%

Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients

et al. 2021

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The etiological agent of COVID-19 SARS-CoV-2, is primarily a pulmonary-tropic coronavirus. Infection of alveolar pneumocytes by SARS-CoV-2 requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase. ACE2, present on the surface of many cell types, is known to be a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (Ang II) into Angiotensin-(1-7) [Ang-(1-7)]. We therefore hypothesized that SARS-CoV-2 could trigger variations of ACE2 expression and Ang II plasma concentration in SARS-CoV-2-infected patients. We report here, that circulating blood cells from COVID-19 patients express less ACE2 mRNA than cells from healthy volunteers. At the level of circulating cells, this ACE2 gene dysregulation mainly affects the monocytes, which also show a lower expression of membrane ACE2 protein. Moreover, soluble ACE2 (sACE2) plasma concentrations are lower in prolonged viral shedders than in healthy controls, while the concentration of sACE2 returns to normal levels in short viral shedders. In the plasma of prolonged viral shedders, we also found higher concentrations of Ang II and angiotensin I (Ang I). On the other hand, the plasma levels of Ang-(1-7) remains almost stable in prolonged viral shedders but seems insufficient to prevent the adverse effects of Ang II accumulation. Altogether, these data evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.

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Section: Discussionmentioning

confidence: 55%

Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients

et al. 2021

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“…Low levels of potassium during admission have been associated with poor prognosis and severe disease, but little is known of the dynamics over time in COVID-19 ( 23 , 24 ). Increased levels of urinary potassium have been found in critically ill patients with COVID-19 ( 25 ). Chloride homeostasis has been briefly discussed in previous studies without finding any prognostic value of the level during admission ( 26 ).…”

Section: Introductionmentioning

confidence: 99%

Electrolyte and acid-base imbalance in severe COVID-19

Sjöström

Rysz

Sjöström

et al. 2021

Endocrine Connections

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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.

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“…One more study done by Gelatino et al had mild severity of hypokalemia (90.7% had serum levels of K+ between 3.4 and 3 meq/l) and there is no associated mortality with hypokalemia in this group. 9 Unlike other study done by Chen et al hypokalemia was prevalent among the patients with COVID-19, among 54% (95 of 175) of patients had plasma K+ less than 3.5 mmol/l. 6…”

Section: Discussionmentioning

confidence: 58%

“…In our study demographic characteristics of the study subjects studied showed that males were higher as compared to females which was similar to 51.5% of patients were male in study conducted by Liu et al 10 Similar study was done by Mousavi-Nasab et al where 57.1% were males. 9 Subjects taken were aged above 65 years, 80 (30.2%) followed by age group of 36 to 45 years, 51 (19.2%) with average age of 58.70±15. Similar study done by Liu et al showed average age was 62.1±14.6 years.…”

Section: Discussionmentioning

confidence: 98%

Study of hypokalemia and correlation with severity of disease in patients with COVID-19 positive severe acute respiratory illness and COVID-19 negative severe acute respiratory illness

et al. 2021

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Background: Although the coronavirus disease-2019 (COVID-19) pandemic is creating a major global health crisis, the risk factors for mortality and the detailed clinical course of disease has not yet established. Clinical spectrum of the disease varies from mild symptoms to ARDS. The main objective of this study was to determine hypokalemia and correlation of severity of disease with hypokalemia in patients with COVID-19 positive SARI (severe acute respiratory illness) and COVID-19 negative SARI patients.Methods: The study was a cross-sectional study conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI from April 2019 to December 2019. History was taken, general and systemic examination was done. Patients were categorized and selected patients with moderate and severe illness. RT-PCR for COVID-19 patients done using throat and nasal swab. Potassium levels were estimated and correlated with severity of illness in patients with COVID-19 positive and COVID-19 negative status.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVD-19 positive (severe) was higher, 58.70±15.598 followed by COVID-19 positive (moderate), 55.13±14.480. About 30% (N=90) belonged to severe SARI group, Chi square test showed statistical significant association with respect to age. In this study there was no statistically significant hypokalemia found between COVID-19 positive SARI patients (N=20, 14.81%) and COVID-19 negative SARI patients (N=17, 13.07%). However hypokalemia COVID-19 positive SARI patients 14.81% (N=20) and COVID-19 negative SARI patients 13.07% (N=17). And also there is no statistically significant hypokalemia between SARI severe and SARI moderate cases.Conclusions: However in this study there is no statistically significant hypokalemia found between COVID-19 positive SARI patients and COVID-19 negative SARI patients. And also there is not statistically significant hypokalemia between SARI severe and SARI moderate cases. Hypokalemia is found in both in both COVID-19 positive SARI patients and COVID-19 negative SARI patients and relatively more in COVID-19 positive patients. Hypokalemia is one of the treatable condition and early detection and treatment reduces mortality.

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Hypokalemia in Patients with COVID-19

Cited by 90 publications

References 25 publications

Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients

Expression of ACE2, Soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin-(1-7) Is Modulated in COVID-19 Patients

Electrolyte and acid-base imbalance in severe COVID-19

Study of hypokalemia and correlation with severity of disease in patients with COVID-19 positive severe acute respiratory illness and COVID-19 negative severe acute respiratory illness

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