Endocrine Abstracts

Introduction

SARS-CoV-2 has caused a global outbreak of coronavirus disease 2019 (COVID-19). It is known that this virus binds angiotensin-converting enzyme 2 (ACE2) of the renin-angiotensin system, which may exert substantial effects on sodium and potassium metabolism. Viral pneumonia and respiratory distress are well known etiologies for hyponatremia due to syndrome of inadequate secretion of antidiuretic hormone, and can worsen clinical course of the disease and outcomes.

Aim

To investigate the prevalence of electrolyte disturbances (hyponatremia, hypokalemia) in patients with COVID-19.

Materials and methods

We examined medical records of 153 patients, which were hospitalized for inpatient treatment of COVID-19 infection from May to June 2020. Study group included 75 men (49%) and 78 women (51%), median age 60 years [Q1 47; Q3 73], BMI 28.7 kg/m² [25.0; 32.9]. All patients were diagnosed with pneumonia due to SARS-CoV-2 with median percent of lung involvement 28.5% [15.3; 44.7]. Median SpO2 was 94% [92; 97], and median NEWS score was 3 [2; 6]. There were 10 lethal cases. 14 patients at admission received diuretic therapy.

Results

On admission, the median natremia was 137 mmol/l [135; 139], hyponatremia (Na < 135 mmol/l) was detected in 25% (95% CI 18–32%), profound hyponatremia (Na < 130 mmol/l) – in 4.6% (2–9%), hypernatremia (Na > 145 mmol/l) in 0.6% (0–4%) of patients. Median potassium levels were 3.8 mmol/l [3.5; 4.2], hypokalemia (K < 3.5 mmol/l) was detected in 17.6% (12–25%), hyperkalemia (K > 5.1 mmol/l) in 2.6% (1–7%) of patients. Diabetes mellitus (DM) was observed in 15% of patients and was associated with lower Na levels 135 mmol/l [132; 136] vs 137 mmol/l [135; 139] in patients without DM (P = 0.003, Mann-Whitney test), and not with K levels. Na and K levels at admission were not associated with diuretic use by patients.

Conclusions

Our data suggests that hospitalized patients with COVID-19 infection have the high prevalence of impairment of sodium and potassium homeostasis, up to 32% and 25% respectively.