Evaluation of serum electrolyte levels in patients with COVID-19 diagnosed in the emergency department

Evaluation of Serum Electrolyte Levels in Patients with COVID-19 Diagnosed in the Emergency Department Objective: We aimed to analyze the serum electrolyte levels of COVID-19 patients diagnosed with positive PCR test in the Emergency Department and to evaluate the effect of serum electrolyte levels on disease prognosis, length of hospitalization and mortality. Material and Method: Patients who presented to Çukurova University Medical Faculty Hospital Emergency Department between 01.03.2020-01.04.2021 and had positive COVID-19 PCR test were included in this retrospective cross-sectional study. Patients who did not have serum electrolyte values and missing data were excluded from the study. Demographic data, laboratory data, vital signs, clinical presentation and hospitalization intervals and outcomes of the patients were recorded. Results: A total of 350 patients were evaluated. The mean age of the patients was 55.9 years and 51.4% (n=180) were male. 24.3% (n=85) of all patients were discharged directly from the Emergency Department, 58.3% (n=204) were hospitalized in the ward and 17.4% (n=61) in intensive care units. The mean of neutrophil/lymphocyte ratio was 3.3 in discharged patients, this rate was found to be 26.5 in patients hospitalized in the intensive care unit and 43.8 in patients who had died. If the neutrophil/lymphocyte ratio exceeds 6.4, mortality can be estimated with 69% sensitivity and 70% specificity. The most common electrolyte disturbances observed in the patients were hypocalcemia (47.7%), hypochloremia (43.7%) and hyponatremia (40.3%), respectively. Incidence of hyponatremia was 27% in discharged patients, it was 62.1% in patients who had died. The rate of hyponatremia was found to be significantly higher in patients who were hospitalized compared to patients who were discharged from the Emergency Department (p=0.017). The second most common electrolyte disorder in patients who had died was hyponatremia. Except for the discharged patients from the Emergency Department, the most common electrolyte disorder was hypocalcemia (47.4%), and the rate of hypocalcemia, increased as the disease had progressed. The incidence of hypocalcemia in patients who died was 79.3%. The rate of hypocalcemia was found to be significantly higher in patients who were hospitalized than patients who were discharged from the Emergency Department (p=0.001). The least observed electrolyte deficiency among all patient groups was hypokalemia (10.6%). The rate of hypokalemia and hyperkalemia in hospitalized patients was found to be significantly higher than in patients who were discharged (p=0.001). The incidence of hypomagnesemia was 12.9% in discharged patients, 27.2% in hospitalized patients, and 55.2% in patients who had died. The incidence of hypomagnesemia was found to be higher in hospitalized patients compared to discharged patients, and it was found to be significantly higher in patients hospitalized in the intensive care unit compared to patients who were hospitalized in the ward. (p=0.001). The rate of hypochloremia was found to be 43.7% in all COVID-19 patients. The rate of hypochloremia observed in the hospitalized patients was 47.5%. There was no significant difference in means of hypochloremia among the hospitalized patients according to the hospitalized ward or death status. Conclusion: We assume that serum electrolytes measured at the time of presentation of the COVID-19 patients were associated with the prognosis of the disease. Serum electrolyte values should be evaluated in COVID-19 patients who presented to the Emergency Department. Patients with low magnesium, chlorine and calcium levels should be followed carefully. Early replacement of deficient electrolytes might affect the outcome. Key Words: Calcium, Chlorine, COVİD-19, Magnesium, Potassium, Sodium