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Cancarevic I, Nassar M, Foster A, Umar Z, Parikh A, Ahammed MR, Shaban L, Abosheaishaa H, Mergen D, Amin T, Ozkan BI, Sánchez Ruiz AM, Hosna A, ul Rasool MH, Ahmed N, Ayotunde F, Ashfaq S, Lopez R, Rizzo V. Electrolyte disturbances in patients hospitalized for COVID-19 infection: An observational study. Medicine (Baltimore) 2024; 103:e37749. [PMID: 38758907 PMCID: PMC11098206 DOI: 10.1097/md.0000000000037749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/07/2024] [Indexed: 05/19/2024] Open
Abstract
There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ± 6.13, 4.38 ± 0.69, 3.53 ± 0.69, and 2.03 ± 0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ± 5.06, 4.18 ± 0.59, 3.578 ± 0.59, and 2.11 ± 0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ± 15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ± 17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ± 0.76), and magnesium (N = 115, mean = 2.12 ± 0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ± 0.60 for potassium and N = 118, mean = 1.933 ± 0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed.
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Affiliation(s)
- Ivan Cancarevic
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Mahmoud Nassar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY, USA
| | - Allison Foster
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Zaryab Umar
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Avish Parikh
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Md Ripon Ahammed
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Lilia Shaban
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Hazem Abosheaishaa
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Damla Mergen
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Toka Amin
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Bike Ilayda Ozkan
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | | | - Asma Hosna
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | | | - Nazaakat Ahmed
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Fatima Ayotunde
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Salman Ashfaq
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Ricardo Lopez
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Vincent Rizzo
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
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Shaban L, Toz B, Ramdass A. Workplace- and Residence-Associated Leptospirosis: A Case Report and Review of Current Literature. Cureus 2022; 14:e29879. [PMID: 36348921 PMCID: PMC9629868 DOI: 10.7759/cureus.29879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Leptospirosis is a zoonotic infection most commonly occurring in tropical regions through contact with water or soil contaminated with animal urine. In New York, approximately one to three cases occur annually, the majority occurring through workplace exposure to animal reservoirs. In cases of the more severe presentation of leptospirosis, Weil’s disease, it is important to identify the infection promptly to allow for early antibiotic initiation as well as early initiation of daily dialysis in cases in which it is necessary. We present a case of Weil’s disease in a 64-year-old male with presumed exposure through his combined workplace and residential environment. The resolution of symptoms occurred through a combination of hemodialysis, doxycycline, and meropenem antibiotic treatment. We also discuss the barriers to diagnosis, including the non-specific presentation of leptospirosis, the limitation of access to testing centers, and the limitations to antibody testing within the first week of symptom presentation due to low antibody levels.
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Nyabera A, Shaban L, Hijazin K, Tumarinson T. Community-Acquired Methicillin-Resistant Staphylococcus Aureus Hepatic Liver Abscess. Cureus 2021; 13:e12560. [PMID: 33564551 PMCID: PMC7863055 DOI: 10.7759/cureus.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A methicillin-resistant Staphylococcus aureus (MRSA) liver abscess is a rare infection that if not recognized, and treated early, can be fatal. There is limited literature demonstrating possible etiologies of MRSA liver abscesses, whether nosocomial or community acquired. We present a case of a 45-year-old Guyanese male with a 30 pack-year smoking history. The patient presented with both generalized abdominal pain and a productive cough on two separate occasions. Laboratory results in his second presentation revealed leukocytosis with increased alanine transaminase (ALT). Imaging revealed a multiloculated abscess in the inferior aspect of the liver, measuring 5.1 cm x 3.4 cm x 4 cm, and chest X-ray revealed developing consolidation within the right perihilar region. The patient underwent percutaneous liver drainage via pigtail catheter. Fluid cultures grew MRSA. The patient was placed on vancomycin for three weeks. On subsequent examinations, there was a resolution of leukocytosis with no drainage from the pigtail catheter. Elevations of aspartate transaminase (AST), ALT, and gamma-glutamyl transferase (GGT) were observed. Therefore, in addition to restarting vancomycin, the patient was started on ciprofloxacin for two weeks and liver function tests (LFTs) trended downwards, without recurrence of symptoms. High suspicion for liver abscess should exist in patients that present with complaints of abdominal pain and elevated LFTs when a previous source of infection has been observed. MRSA liver abscesses are rare and potentially fatal, therefore, early recognition and appropriate management is essential.
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Affiliation(s)
- Akwe Nyabera
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Lilia Shaban
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Kristin Hijazin
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Taisiya Tumarinson
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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