Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.

92079Volume 24

Journal of Advances in Medical and Pharmaceutical

Sciences
Volume 24, Issue 10, Page 33-36, 2022; Article no. JAMPS.92079ISSN: 2394-1111

PATTERN OF ELECTROLYTE, UREA AND CREATININE IN COVID-19

PATIENTS MANAGED IN THE FIRST AND SECOND WAVES AT FMC OWERRI.

OHIRI, J. U., SIMON, M. J., OBI, P. C., ACHIGBU, K.

Federal Medical Center, Owerri, Imo State, Nigeria

ABSTRACT
An analysis of electrolyte, urea and creatinine levels among 242 COVID-19 patients was
carried out during their admission at the COVID-19 isolation unit in the Federal medical
center, Owerri. The data showed that 57.0% of the participants were male and 43.0% of the
participants were female. It was observed that 3.3% were below 20 years, while 32.2% were
between 31-40 and 17.4% were at least 60 years old. It was observed that 33.5% of the
patients were symptomatic, compared to 66.5% that were asymptomatic. Among the
patients, 9.5% had elevated sodium levels, 9.1% had elevated potassium levels, 32.2% had
elevated creatinine levels and 30.9% had elevated urea levels. There was a statistically
significant difference (p = 0.001) between the mean creatinine levels of persons with
symptoms (81.8±31.1) compared to persons with no symptoms (94.5±19.0). The data
showed that symptoms were 10.1 (5.2 – 18.9) times more likely among persons ≥40 years.
Abnormal sodium levels were 1.1 (0.5 – 2.3) times more likely among persons with
symptoms, abnormal creatinine levels were 23.2 (7.8 – 68.7) times more likely among
persons with symptoms and abnormal urea levels was 56.4 (24.2 – 132.1) times more likely
among persons with symptoms. The distribution of abnormal creatinine and urea were
statistically significantly higher among persons with symptoms (p < 0.0001). Despite rich
information on the sequalae manifestations of COVID-19, supportive care remains the best
available mode of treatment with no particular medication readily available, Vaccination
remains the best form of prevention and is highly recommended to prevent severe public
health and socio-economic consequences in the event of an outbreak

Keywords: COVID-19, Urea, Creatinine, Potassium, Sodium

1. INTRODUCTION of COVID-19 continues to rise despite the

The Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) also known
as COVID-19, which started in December
2019 from China, has infected people in all
continents and countries of the world[1].
The infection has been recorded in 621
million people globally leading to over 6
million deaths[2]. Nigeria has recorded
over 200 thousand cases of COVID-19 with
over 3 thousand deaths[3]. The global toll
availability of vaccines, as vaccine
hesitancy still exists in areas of world and
in some parts of the world, there seem to be
no vaccines available for the population[2,
4].
The infection causes a variety of symptoms
in the population with most being
asymptomatic in across different groups,
furthermore, laboratory findings details
shows different abnormal expressions of

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 Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.92079Volume 24
biochemicals in the body[5, 6]. The SARS-
CoV-2 virus that causes COVID-19 enters
human cells via the ACE2 receptor. The
infection first occurs in upper airways and
at later stages may proceed to the lung,
gastrointestinal tract, kidney, heart, or
brain[1, 7]. ACE2 and its antagonistic
homolog ACE are core enzymes of the
renin–angiotensin–aldosterone system
(RAAS), which regulates electrolyte
homeostasis, blood pressure, and
cardiovascular health, as well as restores
balance when there are extreme changes in
the expression of extracellular fluid[8, 9].
The antagonistic effects of ACE and ACE2
are largely achieved by increases or
decreases of the amount of circulating
Angiotensin II. Angiotensin II is a potent
secretagogue of aldosterone, an adrenal
cortex hormone that enhances renal
reabsorption of sodium and water,
excretion of potassium, and the
maintenance of acid–base balance[8, 10,
11]. Many patients had multiple co-
occurring electrolyte disorders at
presentation. Studies have shown some
levels of abnormal electrolyte expression
among persons diagnosed of COVID-
19[10–12]. The treatment of COVID-19
remains largely supportive, with a number
of cases requiring oxygen supplementation
and intensive care[5, 13, 14]. Nonetheless,
COVID-19 preventive measures has more
effective and are less burdensome on the
health system. The current study assessed
the pattern of electrolyte, urea and
creatinine expression among COVID-19
patients during the First and Second Waves
in the Federal Medical Center, Owerri,
Nigeria.
2. METHODS
Study Area
The study was carried out at the Federal
Medical center, Owerri, Imo state, Nigeria.
The center operated a COVID-19 isolation
34
center at the first and second waves of the
COVID-19 pandemic in Nigeria.
Study Population
The study population consisted of persons
that tested positive for SARS-COV-2 on
nasopharyngeal and oropharyngeal swabs
tested using the polymerase chain reaction
and were admitted and were managed for
COVID-19 at the Federal Medical Center
Owerri.
Data Collection
A structured PROFORMA data collection
sheet was used to obtain the demographic
and clinical information of the study
participants from the medical charts and
laboratory tests carried out during
admission at the hospital.
Data Analysis
The data collected was analyzed with the
SPSS v25 software at a 95% confidence
interval and a p-value less than 0.05 was
considered significant. Measures of central
tendency and summary statistics was used
to present the data as appropriate. The mean
levels of electrolytes analyzed was
compared between symptomatic and
asymptomatic persons using the
Independent T-Test. Chi-square analysis
and logistic regression was used to assess
the different categories of electrolyte levels
with the presence of symptoms among the
participants.
Ethical Consideration
Ethical approval was obtained from the
Health Research and Ethics Committee of
Federal Medical Center, Owerri. All patient
data was anonymized and handled only by
authorized personnel in order to ensure
confidentiality.
3. RESULTS
Table 1 shows the demographic
information of the study subjects. The table
showed that 57.0% of the participants were
male and 43.0% of the participants were
female.
 Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.92079Volume 24

Table 1: Demographic variables of subjects

Variables Frequency Percent

(n=242) (%)
Gender
Male 138 57.0
Female 104 43.0
Age groups
<20 8 3.3
21 - 30 48 19.8
31 - 40 78 32.2
41 - 50 34 14.0
51 - 60 32 13.2
Above 60 42 17.4

The Figure 1 shows that 33.5% of the patients were symptomatic, compared to 66.5% that were
asymptomatic.

Yes
81, 33.5%
No
161, 66.5%

Figure 1: Presence of COVID-19 symptoms

Table 2 shows the pattern of electrolyte, urea and creatinine among the participants. It was
observed the 83.8% had normal sodium, while 76.03% had normal potassium levels and
66.53% had normal creatinine levels. Also, 67.7% had normal urea levels. Among the
symptomatic patients, 9.5% had elevated sodium levels, 9.1% had elevated potassium levels,
32.2% had elevated creatinine levels and 30.9% had elevated urea levels.

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 Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.92079Volume 24
Table 2: Pattern of electrolyte, urea and creatinine
Analytes Normal Low Elevated Total
n (%) n (%) n (%) n (%)
Sodium 203(83.88) 16(6.61) 23(9.50) 242(100.0)

Potassium 184(76.03) 36(14.88) 22(9.09) 242(100.0)

Creatinine 161(66.53) 3(1.24) 78(32.23) 242(100.0)

Urea 164(67.77) 3(1.24) 75(30.99) 242(100.0)

Table 3 shows that the mean creatinine among persons with symptoms was 181.8±31.1mmol/L
compared to 94.5±19.0 mmol/L among persons with no symptoms. The mean sodium levels
among persons with symptoms was 137.7±6.6 mmol/L compared to 139.0±8.0 mmol/L among
persons with no symptoms, while the mean potassium levels among persons with symptoms
was 4.0±0.7 mmol/L compared to 4.4±2.7 mmol/L among persons with no symptoms. The
table also showed that the mean urea levels was 9.2±2.1 mmol/L among persons with
symptoms and 5.6±3.2 mmol/L among persons with no symptoms. There was no statistically
significant difference (p >0.05) in the mean electrolyte levels between persons with symptoms
and persons with no symptoms. However, there was a statistically significant difference (p =
0.001) between the mean creatinine levels of persons with symptoms and persons with no
symptoms.
Table 3: Comparison of electrolyte, urea and creatinine by presence of symptoms.
Symptoms No Symptoms T-test (p-value)
Sodium (mmol/L) 137.7±6.6 139.0±8.0 0.430
Potassium (mmol/L) 4.0±0.7 4.4±2.7 0.217
Creatinine (mmol/L) 181.8±31.1 94.5±19.0 0.001*
Urea(mmol/L) 9.2±2.1 5.6±3.2 0.291
All figures are presented in Mean ±SD.
*Difference is statistically significant (p<0.05).

Table 4 shows that 59.3% of persons ≥40 years had symptoms, compared to only 12.7% of
persons <40 years. The data showed that symptoms were 10.1 (5.2 – 18.9) times more likely
among persons ≥40 years. Abnormal sodium levels were 1.1 (0.5 – 2.3) times more likely
among persons with symptoms, abnormal creatinine levels were 23.2 (7.8 – 68.7) times more
likely among persons with symptoms and abnormal urea levels was 56.4 (24.2 – 132.1) times
more likely among persons with symptoms. The distribution of abnormal creatinine and urea
were statistically significantly higher among persons with symptoms (p < 0.0001).

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 Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.92079Volume 24
Table 4: Association of demography, electrolyte, creatinine and urea levels with presence
of symptoms.
Variables Symptoms No Symptoms Total Chi-square OR (95% C.I)
n (%) n (%) n (%) (p-value)
Gender
Male 43(31.2) 95(68.8) 138(100.0) 0.77 (0.380) 0.8 (0.4 – 1.3)
Female 38(36.5) 66(63.5) 104(100.0)
Age groups
≥40 years 64(59.3) 44(40.7) 108(100.0) 58.25 (0.0001)* 10.1 (5.2 – 18.9)
<40 years 17(12.7) 117(87.3) 134(100.0)
Sodium
Abnormal 14(35.9) 25(64.1) 39(100.0) 0.12 (0.7259) 1.1 (0.5 – 2.3)
Normal 67(33.0) 136(67.0) 203(100.0)
Creatinine
Abnormal 74(91.4) 7(8.6) 81(100.0) 183.2 (<0.0001)* 23.2 (7.8 – 68.7)
Normal 7(4.3) 154(95.7) 161(100.0)
Urea
Abnormal 66(84.6) 12(15.4) 78(100.0) 135.2 (<0.0001)* 56.4 (24.2 – 123.1)
Normal 15(9.1) 149(90.9) 164(100.0)
Potassium
Abnormal 5(22.7) 17(77.3) 22(100.0) 1.25 (0.262) 0.5 (0.1 – 1.5)
Normal 76(34.5) 144(65.5) 220(100.0)
*Distribution is statistically significant (p<0.05).
4. DISCUSSION considerable proportion of persons the test
positive for SARS-COV-2 in different
The findings of the current study showed settings[10, 14, 18].
that about one -third of the patients
admitted were symptomatic. This is There was no statistically significant
consistent with reports of similar studies difference (p >0.05) in the mean electrolyte
conducted in other parts of Nigeria, levels between persons with symptoms and
reporting that between 25 – 40% of persons persons with no symptoms. This finding
managed in the COVID-19 isolation wards contrasts with reports of other studies
were symptomatic [4, 11, 14, 15]. Among conducted among patients that test positive
the patients, 9.5% had elevated sodium for SARS-COV-2 in East Kuwait[10],
levels, this is in contrast with the findings Northern Nigeria[19] and South Korea[1].
of a similar study by Yen et al., which These observed differences could be
reported elevated sodium levels in about attributed to the variations in the severity of
20% of persons diagnosed of COVID- symptoms across the different studies in
19[16]. The current study also showed that comparison to the current study. Our
9.1% had elevated potassium levels, these findings shows that average creatinine
findings are similar to the reports of similar levels among symptomatic persons was
studies reporting elevated electrolyte levels statistically significantly higher compared
in 5 – 40% of patients that test positive for to asymptomatic persons. This is consistent
SARS-COV-2[11, 15, 17]. It was also with the reports of similar studies which
observed that 32.2% had elevated indicated a significantly elevated level of
creatinine levels and 30.9% had elevated creatinine among symptomatic COVID-19
urea levels. Elevated creatinine and urea patients[18, 20]. Tissues with significant
levels have also been reported in a

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 Ohiri et al.; J. Adv. Med. Pharm. Sci., vol. 24, no. 10, pp. 33-38, 2022; Article no.JAMPS.92079Volume 24
ACE2 expression levels include the heart,
the stomach, and the kidneys, in addition to
the alveolar cells in the lungs[21].
Our study showed that symptoms were 10.1
(5.2 – 18.9) times more likely among
persons ≥40 years. Abnormal sodium levels
were 1.1 (0.5 – 2.3) times more likely
among persons with symptoms, abnormal
creatinine levels were 23.2 (7.8 – 68.7)
times more likely among persons with
symptoms and abnormal urea levels was
56.4 (24.2 – 132.1) times more likely
among persons with symptoms. These
findings echo the reports of various clinic-
based studies which reports significantly
increased odds of COVID-19 symptoms
among persons with abnormal (low or
elevated) levels of electrolytes, creatinine
and urea[1, 11, 13, 21].
The occurrence of the abnormal expression
of electrolytes and the biochemical levels of
creatinine and urea concurrently indicates
the need for supportive care and organ
specific care among persons that test
positive for SARS-COV-2. Despite rich
information on the sequalae and
management of COVID-19, supportive care
remains the best available mode of
treatment with no particular medication
readily available, Vaccination remains the
best form of prevention and is highly
recommended to prevent severe public
health and socio-economic consequences in
the event of an outbreak.
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