Evaluation of Serum Electrolyte Balance in Pediatric Patients Diagnosed with COVID-19

Abstract

Objective: In this study, it was aimed to evaluate possible electrolyte imbalances in pediatric patients with COVID-19 positivity. Material and Method: Patients aged 1 month to 18 years, who had COVID-19 symptoms or a history of contact, and who underwent COVID 19 PCR antigen testing were included in this study. The physical examinations, symptoms, laboratory findings and follow-ups of the patients were examined retrospectively. The findings and laboratory results between cases with positive and negative COVID 19 tests were compared. Student t test and Mann Whitney U test were used for statistical analysis. Results: Clinical and laboratory findings of a total of 300 patients were evaluated. The mean age of the patients was 9.6±6.1 years. Nasopharyngeal COVID-19 PCR antigen test was positive in 155 (51.7%) patients. Myalgia findings showed a statistically significant difference in patients diagnosed with COVID-19 test-positive, compared to the test-negative group (p<0.05). There was no significant difference in sodium, potassium and chlorine levels between COVID-19 positive and negative groups (p>0.05). There was no significant difference between the degree of clinical severity and electrolyte levels (p=0.676). Conclusion: Pediatric patients are at greater risk for fluid and electrolyte disorders in the presence of infection. Fluid and electrolyte disorders are more common especially in pediatric patients hospitalized in hospitals and intensive care units. Therefore, fluid and electrolyte status should be monitored in children with COVID 19 infection.

Keywords

• COVID 19
• pediatric patients
• electrolyte imbalances

COVİD-19 Tanısı Alan Çocuk Hastalarda Serum Elektrolit Dengesinin Değerlendirilmesi

Abstract

Amaç: Çalışmamızda COVID-19 pozitifliği tespit edilen çocuk hastalarda olası elektrolit bozukluğunu değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: COVID-19 semptomları veya temas öyküsü olan, COVID 19 PCR antijen test uygulanan 1 ay-18 yaş arası hastalar çalışmaya dahil edildi. Hastaların fizik muayeneleri, semptomları, laboratuvar bulguları ve izlemleri geriye dönük olarak incelendi. COVID 19 test pozitif ve negatif olan vakalar arası bulgular ve laboratuvar sonuçları karşılaştırıldı. İstatiksel analiz için Student t test ve Mann Whitney U testi kullanıldı. Bulgular: Toplam 300 hastanın klinik ve laboratuvar bulguları değerlendirilmiştir. Hastaların yaş ortalaması 9,6±6,1 yıldır. Nazofaringeal COVID-19 PCR antijen testi 155 (%51,7) hastada pozitif tespit edildi. Miyalji bulgusu COVİD-19 tanısı almış hastalarda test negatif gruba göre istatistiksel olarak anlamlı farklılık göstermiştir (p<0,05). COVID-19 pozitif ve negatif grup arasında sodyum, potasyum ve klor düzeyleri arasında anlamlı fark saptanmadı (p>0,05). Klinik ciddiyet derecesi ile elektrolit düzeyleri arasında anlamlı bir fark saptanmadı (p=0,676). Sonuç: Enfeksiyon varlığında çocuklar sıvı ve elektrolit bozuklukları açısından daha büyük risk altındadır. Özellikle hastanede ve yoğun bakımda yatan çocuk hastalarda sıvı ve elektrolit bozuklukları daha sık görülmektedir. Bu nedenle COVID 19 enfeksiyonlu çocuklarda sıvı ve elektrolit durumu takip edilmelidir.

Keywords

• COVID 19
• çocuk hasta
• elektrolit bozukluğu

References

1. KAYNAKÇA 1. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virüs origins and receptor binding. Lancet 2020;395(10224):565-574.
2. 2. Hamming I, Timens W, Bulthuis ML, et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus: a first step in understanding SARS pathogenesis. J Pathol 2004;203(2):631-637.
3. 3. Imai Y, Kuba K, Rao S, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature 2005; 436(7047):112-6.
4. 4. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020;57(3):262-265.
5. 5. Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020;58(7):1021-1028.
6. 6. Chan JF, Yuan S, Kok KH, et al. A familial cluster ofpneumonia associated with the 2019 novel corona-virus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 15; 395:514-23.
7. 7. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosisthan adults. Acta Paediatr 2020;109(6):1088-95.
8. 8. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020;58(7):1135-38.

9. 9. Badal S, Thapa Bajgain K, Badal S, et al. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: a systematic review and meta-analysis. J Clin Virol 2021;135:104715.
10. 10. Göktuğ A, Güngör A, Oz FN, et al. valuation of Epidemiological, Demographic, Clinical Characteristics and Laboratory Findings of COVID-19 in the Pediatric Emergency Department. J Trop Pediatr 2021;67(4):fmab066.
11. 11. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med 2020;58(7):1063-6
12. 12. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506:145-48.
13. 13. Guan WJ, Ni ZY, Hu Y, et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708-1720.
14. 14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
15. 15. Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426(6965):450-4.
16. 16. Mabillard H, Sayer JA. Electrolyte Disturbances in SARS-CoV-2 Infection. F1000Res. 2020; 9:587.
17. 17. Pourfridoni M, Abbasnia SM, Shafaei F, et al. Fluid and electrolyte disturbances in COVID-19 and their complications. Biomed Res Int 2021; 2021:6667047.
18. 18. Aguila EJT, Cua IHY, Fontanilla JAC, Yabut VLM, Causing MFP. Gastrointestinal manifestations of COVID-19: Impact on nutrition practices. Nutr Clin Pract 2020;35(5):800-805.
19. 19. Trottein F, Sokol H. Potential causes and consequences of gastrointestinal disorders during a SARS-CoV-2 infection. Cell Rep 2020;32(3):107915.
20. 20. Hirsch JS, Uppal NN, Sharma P, et al. Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19. Nephrol Dial Transplant 2021;36(6):1135-1138.
21. 21. Tezcan ME, Dogan Gokce G, Sen N, et al. Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients. New Microbes New Infect 2020; 37:100753.
22. 22. Khan F, Khokhar A, Ali Joyo RM, et al. Frequency of electrolyte imbalances (sodium and potassium) in patients with Covid-19 disease. Pakistan Journal of Medical and Health Sciences 2020;14(3):1190-1192. 23. Malieckal DA, Uppal NN, Ng JH, et al. Electrolyte abnormalities in patients hospitalized with COVID-19. Clin Kidney J 2021;14(6):1704-1707.
23. 24. De Carvalho H, Richard MC, Chouihed T, et al. "Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case–control study. Intern Emerg Med 2021;16(7):1945-1950.
24. 25. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med 2007;356(20):2064-72.
25. 26. Yousaf Z, Al-Shokri SD, Al-Soub H, Mohamed MFH. COVID-19-associated SIADH: a clue in the times of pandemic! Am J Physiol Endocrinol Metab 2020;318(6):E882-E885.
26. 27. Chen D, Li X, Song Q, et al. Hypokalemia and clinical implications in patients with coronavirus disease (2019). medRxiv 2020 doi.org/10.1101/2020.02.27.20028530.