Electrolyte Imbalances in COVID-19 Patients
Summary
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the significance of electrolyte homeostasis in both acute infection and convalescence. Electrolyte imbalances such as hyponatraemia, hypokalaemia and hypocalcaemia occur frequently in hospitalised patients and are linked to disease severity, respiratory failure and multiorgan dysfunction. Viral interaction with angiotensin-converting enzyme 2 triggers dysregulation of the renin-angiotensin system, promoting renal potassium loss and sodium–water disturbances. Inflammatory mediators, notably interleukin-6, further exacerbate water retention via inappropriate antidiuretic hormone secretion. Additionally, reduced oral intake, diarrhoea and cytokine-induced shifts in mineral metabolism contribute to derangements in calcium, phosphorus and magnesium. Clinically, these disturbances manifest as neuromuscular irritability, cardiac arrhythmias and altered mental status, and have been identified as independent prognostic factors. Early recognition through routine monitoring and timely correction—ranging from cautious hypertonic saline infusion to mineral supplementation—can improve outcomes and guide resource allocation in critical care settings.
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Electrolyte Imbalances in COVID-19 Patients publication trend
The graph below shows the total number of articles in electrolyte imbalances in covid-19 patients across all publications each year (not limited to Nature Index journals).
Technical terms
Hyponatraemia: A serum sodium concentration below 135 mmol/L, often leading to neurological symptoms if severe.
Hypokalaemia: A serum potassium concentration below 3.5 mmol/L, which can cause muscle weakness and cardiac arrhythmias.
Hypocalcaemia: A serum calcium concentration below 2.1 mmol/L, associated with neuromuscular irritability and metabolic complications.
Syndrome of inappropriate antidiuresis (SIAD): Excessive antidiuretic hormone release causing water retention and dilutional hyponatraemia.
Renin-angiotensin system (RAS): A hormonal cascade regulating blood pressure and fluid balance, disrupted by viral binding to ACE2 receptors.
References
- Calcium, Phosphorus and Magnesium Abnormalities Associated with COVID-19 Infection, and Beyond. Biomedicines (2023).
- Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19. Pituitary (2024).
- Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Frontiers in Endocrinology (2020).
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