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

Maryam Noori, Seyed Aria Nejadghaderi, Mark J.M. Sullman, Kristin Carson-Chahhoud, Mohammadreza Ardalan, Ali Asghar Kolahi, Saeid Safiri

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


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.

Original languageEnglish
Pages (from-to)397-407
Number of pages11
JournalIranian Journal of Kidney Diseases
Issue number6
Publication statusPublished or Issued - Nov 2021
Externally publishedYes


  • COVID-19
  • Etiology
  • Hyperkalemia
  • Physiopathology
  • SARS-CoV-2
  • hypokalemia

ASJC Scopus subject areas

  • Nephrology

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