Terence Chau, BCCCP, BCPS, PharmD
Critical Care Pharmacist
Cooper University Hospital
Conshohocken, Pennsylvania
Disclosure information not submitted.
Diana Solomon, PharmD, BCCCP
Pharmacist
Cooper University Hospital
Camden, United States
Disclosure information not submitted.
Bryan Lee, MD
Dr.
Cooper University Hospital
Camden, NJ, United States
Disclosure information not submitted.
Lauren Igneri, PharmD, BCCCP, BCPS,
Clinical Pharmacy Specialist - Critical Care
Cooper University Health Care
Camden, NJ
Disclosure information not submitted.
Title: Electrolyte Disturbances in COVID-19 Patients Requiring Respiratory Support
Introduction: Drug shortages during the COVID-19 have presented challenges to the provision of optimal supportive care. Electrolyte abnormalities in other respiratory diseases, such as asthma and COPD, have been described and these abnormalities have been associated with poorer prognosis. The purpose of the study was to determine the prevalence of electrolyte disturbances in COVID-19 patients requiring respiratory support, determine the relationship between abnormal electrolytes to subsequent course of care, and quantify the utilization of electrolyte repletion.
Methods: This was an IRB approved single-center, retrospective study. Adult COVID-19 patients on respiratory support < 24 hours of admission were included. The primary outcome was to describe the frequency and distribution of electrolyte abnormalities. Secondary outcomes included: the severity and duration of electrolyte abnormalities; association of electrolyte abnormalities within the first 24 hours to ICU admission, length of stay, escalation of respiratory support; electrolyte repletion utilization, and need for antiarrhythmic therapy.
Results: 139 patients were included in the analysis with 30.2% requiring mechanical ventilation and 52.5% receiving ICU care. Among the total cohort, patients experienced: hyponatremia (50.4%), hypernatremia (23.7%), hypokalemia (44.6%), hyperkalemia (34.5%), hypomagnesemia (25.2%), and hypophosphatemia (56.5%). ICU and mechanically intubated patients were more likely to experience electrolyte abnormalities and required significantly more electrolyte repletion than non-ICU and non-mechanically intubated patients, respectively. There was no association between any initial electrolyte abnormalities with ICU admission or escalation of respiratory support. Most patients (95%) received > 1 medication associated with arrhythmias with severe hypocalcemia patients more likely to receive IV antiarrhythmic therapy (36.5% vs 12%, P = 0.004).
Conclusions: Electrolyte abnormalities in COVID-19 patients requiring respiratory support were frequent. Critically ill patients experienced more severe abnormalities and required more electrolyte repletion than non-critically ill patients. Implementation of aggressive electrolyte monitoring and allocation of IV electrolyte supply to critically ill COVID-19 patients should be considered.