A Review on the Possible Pathophysiology of Potassium Abnormalities in COVID-19


  • Maryam Noori Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  • Seyed Aria Nejadghaderi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mark J.M. Sullman Department of Social Sciences, University of Nicosia, Cyprus
  • Kristin Carson-Chahhoud Australian Centre for Precision Health, University of South Australia, Australia
  • Mohammadreza Ardalan Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Ali-Asghar Kolahi Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Saeid Safiri Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


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 < 5% to > 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.


DOI: 10.52547/ijkd.6552






REVIEW | Kidney Diseases