Abstract
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 2 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 2% in hypernatremia. However, within 2 weeks of hospitalization 42% of the patients developed hypernatremia, more frequently in critically ill patients. Lower levels of sodium and potassium during admission were associated with the need for mechanical ventilation. Decreased pH at admission was associated with both death and the need for mechanical ventilation. Hypernatremia in the ICU was combined with rising base excess and a higher pH. In the group without intensive care, potassium levels were significantly lower in the patients with severe hypernatremia. Presence of hypernatremia during the first 2 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 are an important indicator of severity in COVID-19.
Highlights
Electrolyte and acid-base imbalance are common in many types of severe diseases
Several reports of hyponatremia at admission in COVID-19 patients all indicate that the low initial levels of plasma sodium could be a risk indicator of severe disease and mortality [2, 3, 4, 5]
Based on our findings from a large cohort of patients with severe COVID-19, hyponatremia during admission followed by the development of hypernatremia in the following weeks is common
Summary
Electrolyte and acid-base imbalance are common in many types of severe diseases. In the SARS-Cov-2 pandemic, the combination of respiratory failure and metabolic changes due to organ failure results in unpredictable electrolyte and acid-base patterns.Hyponatremia in severely ill patients in the intensive care unit (ICU) is a known complication of somatic diseases such as pneumonia and heart failure [1]. Electrolyte and acid-base imbalance are common in many types of severe diseases. Several reports of hyponatremia at admission in COVID-19 patients all indicate that the low initial levels of plasma sodium could be a risk indicator of severe disease and mortality [2, 3, 4, 5]. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia in viral pneumonia, and there are multiple case reports of this neuroendocrinological disturbance in COVID-19 patients [6, 7, 8, 9, 10]. In SIADH, there is an increased release of AVP, from the posterior lobe of the pituitary, despite normal or low serum osmolality.
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