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Hyponatremia in COVID-19 patients: Experience from Bangladesh
Md Khairul Islam1, Pratyay Hasan1, Md Mohiuddin Sharif1
1Department of Medicine Dhaka Medical College Hospital Dhaka Bangladesh.
Insights
Hyponatremia, a common finding in hospitalized coronavirus disease 2019 (COVID-19) patients, was prevalent in 63.6% of cases. This electrolyte imbalance was associated with moderate disease severity and specific laboratory markers.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Clinical Chemistry
Background:
- Hospitalized patients with coronavirus disease 2019 (COVID-19) often present with electrolyte imbalances.
- Hyponatremia, characterized by low serum sodium levels, is a frequently observed complication in various medical conditions.
- Understanding the prevalence and clinical associations of hyponatremia in COVID-19 is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of hyponatremia among hospitalized COVID-19 patients.
- To investigate the association between hyponatremia and clinical characteristics, including disease severity.
- To identify laboratory markers associated with hyponatremia in COVID-19 patients.
Main Methods:
- A retrospective study was conducted at Dhaka Medical College and Hospital (DMCH) involving COVID-19 patients admitted between June and August 2020.
- Patients were categorized into hyponatremic (sodium < 135 mM) and normonatremic (sodium ≥ 135 mM) groups based on admission plasma sodium levels.
- Statistical analyses, including Pearson's chi-squared test, Student's t-test, and logistic regression, were employed to compare groups and identify associations.
Main Results:
- Out of 132 COVID-19 patients, hyponatremia was diagnosed in 84 (63.6%).
- Patients with moderate COVID-19 disease had significantly higher odds (2.15 times) of hyponatremia compared to those with severe disease.
- Hyponatremia was independently associated with lower on-admission SpO2, hemoglobin levels, and elevated C-reactive protein.
Conclusions:
- Hyponatremia is highly prevalent in hospitalized COVID-19 patients.
- Serum electrolyte monitoring upon admission and throughout hospitalization is recommended for COVID-19 patients.
- Early identification of hyponatremia may aid in predicting the need for invasive ventilation and optimizing patient management.
Background:
The purpose of the study was to measure the prevalence of hyponatremia and its association with clinical and laboratory characteristics of hospitalized coronavirus disease 2019 (COVID-19) patients at Dhaka Medical College and Hospital (DMCH).
Methods:
This retrospective study was conducted in COVID-19 dedicated wards at DMCH from June to August 2020. Demographic, clinical, and laboratory data were collected from patient treatment sheets. Two groups of COVID-19 patients were retrospectively screened on the basis of plasma sodium level at admission: hyponatremic (sodium < 135 mM, n = 84) or normonatremic (sodium ≥ 135 mM, n = 48) patients. Severity was assessed using World Health Organization classification for COVID-19 disease severity. To compare the two groups, Pearson's χ 2 (qualitative variables) and Student's T tests (quantitative variables) were applied. The link between patients' clinical data and outcomes was investigated using logistic regression model.
Results:
A total of 132 patients were included in the study, with a mean age of 51.41 (±14.13) years. Hyponatremia was found in 84 patients (63.6%) and the remaining 48 patients (36.4%) had normal plasma Na+ values. Among them, 74 (56.06%) presented with severe disease and 53 (40.15%) with moderate disease. At presentation, patients with moderate COVID-19 disease had 2.15 (1.04-4.5) times higher odds of suffering from hyponatremia. Besides, hyponatremia was independently associated with on admission SpO2 (p = 0.038), hemoglobin (p = 0.004), and C-reactive protein (p = 0.001).
Conclusions:
The authors suggest that patients' serum electrolytes be measured during initial hospital admission and then monitored throughout the hospital stay to predict the probability for referral for invasive ventilation and for better management.
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