A review on the possible pathophysiology of potassium abnormalities in COVID-19
Date
2021
Authors
Noori, M.
Nejadghaderi, S.A.
Sullman, M.J.M.
Carson Chahhoud, K.
Ardalan, M.
Kolahi, A.A.
Safir, S.
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Iranian Journal of Kidney Diseases, 2021; 15(6):397-407
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Abstract
Coronavirus disease 2019 (COVID-19) is a catastrophic contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrolyte disturbances are common complications of COVID-19. The present article examined the potential mechanisms of hypokalemia and hyperkalemia in patients suffering from COVID-19, in order to raise awareness of potassium disorders in SARS-CoV-2 infections. PubMed, Scopus, and Google Scholar were searched with keywords, such as “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “Hypokalemia”, “Hyperkalemia”, “Serum potassium”, and “Etiology”, “Pathophysiology” up to April 20, 2021 without any search filters.
We included articles that proposed potential mechanisms for potassium abnormalities in COVID-19 patients. Furthermore, we used backward and forward citation searching. Potassium abnormalities are considered to be important electrolyte disturbances, with reported incidences ranging from [removed] 50% in patients affected by SARS-CoV-2. Therefore, understanding the etiologies of potassium abnormalities could help to improve disease outcome. Utilization of ACE2 by SARS-CoV-2 in the renal cells, viral-induced tubular injury, and gastrointestinal abnormalities, such as anorexia, diarrhea, and vomiting may predispose COVID-19 patients to developing hypokalemia.
Furthermore, depleted magnesium levels make hypokalemia refractory to treatments. In addition, hyperkalemia may occur because of reduced urinary output, as a consequence of renal failure. Changes in blood pH and medication-induced side-effects are other possible reasons for the deviation of potassium levels from the normal range. The etiology of potassium abnormalities in COVID-19 patients is multifactorial. Therefore, the early detection and management of potassium disorders is vital and would improve the outcome of patients with COVID-19.
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Copyright 2021 Iranian Society of Nephrology