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Research Article
Hypernatremia is common in patients with severe COVID-19 and indicates a poor prognosis
Anna Sjöström
Karolinska Institutet
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
Background: Fluid homeostasis, including electrolyte balance, is dependent on an interaction between the renin-angiotensin-aldosterone system (RAAS) and the release of arginine vasopressin from the pituitary. An imbalance can lead to both hypo- and hypernatremia.
We investigated the frequency, dynamics and severity of electrolyte imbalance in critically ill patients with COVID-19.
Methods: In this retrospective cohort study 223 patients with confirmed COVID-19, treated at the intensive care unit (ICU), were included. Levels of electrolytes, base excess, pH and serum osmolality were collected from the laboratory database. Clinical data was retrieved from patients’ medical records.
Results: Hyponatremia was present in 63% of the patients, at admission. Within two weeks of hospitalization, 65% of the patients developed hypernatremia often combined with a rise of base excess. The mortality rate was twice as high in the group with hypernatremia compared to the patients not developing hypernatremia. Treatment of hypertension before the onset of COVID-19 was more common in patients without hypernatremia.
Conclusion: Our study shows that hypernatremia is very common in severe COVID-19. Patients that developed hypernatremia needed longer time in ICU and had a higher risk of dying, suggesting that the level of sodium is an important indicator of severity in COVID-19.
Keywords
COVID-19, SARS-Cov-2, Electrolytes, Fluid balance, Aldosterone, AVP
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Lydia
commented on 30 January, 2021
Is hypernatremia possible in seemingly mild cases, 97% oxygen saturation with mild flu-like symptoms
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This is a preprint. It has not completed peer review.
Research Article
Hypernatremia is common in patients with severe COVID-19 and indicates a poor prognosis
Anna Sjöström
Karolinska Institutet
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 23 Sep, 2020
Community comments: 1
Metrics
Comments: 1
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
Background: Fluid homeostasis, including electrolyte balance, is dependent on an interaction between the renin-angiotensin-aldosterone system (RAAS) and the release of arginine vasopressin from the pituitary. An imbalance can lead to both hypo- and hypernatremia.
We investigated the frequency, dynamics and severity of electrolyte imbalance in critically ill patients with COVID-19.
Methods: In this retrospective cohort study 223 patients with confirmed COVID-19, treated at the intensive care unit (ICU), were included. Levels of electrolytes, base excess, pH and serum osmolality were collected from the laboratory database. Clinical data was retrieved from patients’ medical records.
Results: Hyponatremia was present in 63% of the patients, at admission. Within two weeks of hospitalization, 65% of the patients developed hypernatremia often combined with a rise of base excess. The mortality rate was twice as high in the group with hypernatremia compared to the patients not developing hypernatremia. Treatment of hypertension before the onset of COVID-19 was more common in patients without hypernatremia.
Conclusion: Our study shows that hypernatremia is very common in severe COVID-19. Patients that developed hypernatremia needed longer time in ICU and had a higher risk of dying, suggesting that the level of sodium is an important indicator of severity in COVID-19.
Figure 1
Figure 2
Lydia
commented on 30 January, 2021
Is hypernatremia possible in seemingly mild cases, 97% oxygen saturation with mild flu-like symptoms