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Letter to the Editor
DOI: 10.1016/j.rec.2020.07.012
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Available online 25 August 2020
Main challenges of electrolyte imbalance in older patients with coronavirus disease and risk of QT prolongation
Principales desafíos del desequilibrio electrolítico en pacientes geriátricos con COVID-19 y riesgo de prolongación del intervalo QT
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Amir Rezazadeha,b, Niayesh Mohebbia,b,
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nmohebbi@sina.tums.ac.ir

Corresponding author:
a Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
b Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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To the Editor,

We read with interest the recent article published by Bonanad et al.1

The topic of this consensus document is valuable and important; however, we encountered ambiguities and questions in one part of the article.

In table 3 of the article, in the description of the adverse cardiovascular effects of drugs investigated for COVID-19 treatment, the authors state that correction of hyperkalemia and hypermagnesemia is vital, while correction of hypokalemia and hypomagnesemia may be particularly imperative since low serum levels of potassium and magnesium enhances the possibility of QT prolongation.2

Hypokalemia, probably by modification of ion potassium channel function, can prolong the QT interval in a manner that results in heterogeneity and dispersion of repolarization. Similarly, hypomagnesemia is a well-established predisposing risk factor for torsade de pointes.3 In addition, potassium deficiency seems to be common in severe coronavirus disease 2019 (COVID-19).4 Several findings indicated that serum potassium should be maintained in the high normal range (4.5-5.0 mmol/L), although more evidence is needed to support this practice.3,5

References
[1]
C. Bonanad, S. García-Blas, F.J. Tarazona-Santabalbina, et al.
Coronavirus: the geriatric emergency of 2020. Joint document of the Section on Geriatric Cardiology of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology.
Rev Esp Cardiol., 73 (2020), pp. 569-576
[2]
E.M. Kallergis, C.A. Goudis, E.N. Simantirakis, G.E. Kochiadakis, P.E. Vardas.
Mechanisms, risk factors, and management of acquired long QT syndrome: a comprehensive review.
ScientificWorldJournal., 2012 (2012), pp. 212178
[3]
B.J. Drew, M.J. Ackerman, M. Funk, et al.
Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation endorsed by the American Association of Critical-Care Nurses and the International Society for Computerized Electrocardiology.
J Am Coll Cardiol., 55 (2010), pp. 934-947
[4]
G. Lippi, A.M. South, B.M. Henry.
Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19).
Ann Clin Biochem., 57 (2020), pp. 262-265
[5]
S.H. Thomas, E.R. Behr.
Pharmacological treatment of acquired QT prolongation and torsades de pointes.
Br J Clin Pharmacol., 81 (2016), pp. 420-427
Copyright © 2020. Sociedad Española de Cardiología
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