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DOI: 10.1016/j.rec.2020.08.018
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Available online 15 October 2020
Main challenges of electrolyte imbalance in older patients with coronavirus disease and risk of QT prolongation. Response
Principales desafíos del desequilibrio electrolítico en pacientes geriátricos con COVID-19 y riesgo de prolongación del intervalo QT. Respuesta
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Clara Bonanada, Pablo Díez-Villanuevab,
Corresponding author
, Sergio García-Blasa, Manuel Martínez-Sellésc,d
a Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
b Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
c Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
d Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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To the Editor,

We appreciate the interest and comments from Rezazadeh et al.1 regarding our article, and we agree on the relevance of electrolyte imbalance in patients with coronavirus 2019 disease (COVID-19), in particular hypokalemia and hypomagnesemia; the reference to hyperkalemia and hypermagnesemia corresponds to a translation error in the document. We would like to point out that hypokalemia, as well as hyponatremia and hypocalcemia, appear to be common in patients with severe clinical forms of COVID-19.2–4 Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs thanks to the binding of the virus to angiotensin-converting enzyme 2, reducing the expression of the enzyme with a consequent increase in circulating angiotensin II, which promotes renal potassium loss.2,3,5 In addition, the inflammatory state and gastrointestinal losses can contribute to these imbalances, with potentially significant consequences due to the association with arrhythmic events secondary to QT interval prolongation (especially torsade de pointes), the risk for which increases with the use of certain drugs and also with the inflammatory state itself.1,5,6 The infection may also predispose to myocardial damage, especially in patients with existing cardiovascular disease.2,3 The pathophysiological changes in aging make older patients particularly vulnerable to electrolyte imbalances, so adequate monitoring and early correction are essential.7

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]
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
[3]
D. Chen, X. Li, Q. Song, et al.
Assessment of hypokalemia and clinical characteristics in patients with coronavirus disease 2019 in Wenzhou China.
JAMA Network Open., 3 (2020), pp. e2011122
[4]
D. Wang, R. Li, J. Wang, et al.
Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan China: a descriptive study.
BMC Infect Dis., 20 (2020), pp. 519
[5]
K.J. Clerkin, J.A. Fried, J. Raikhelkar, et al.
COVID-19 and cardiovascular disease.
Circulation., 141 (2020), pp. 1648-1655
[6]
P.E. Lazzerini, M. Acampa, F. Laghi-Pasini, et al.
Cardiac arrest risk during acute infections: systemic inflammation directly prolongs QTc interval via cytokine-mediated effects on potassium channel expression.
Circ Arrhythm Electrophysiol., (2020),
[7]
L.E. Schlanger, J.L. Bailey, J.M. Sands.
Electrolytes in the aging.
Adv Chronic Kidney Dis., 17 (2010), pp. 308-319
Copyright © 2020. Sociedad Española de Cardiología
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