Hypernatremia and Hyponatremia Worsen COVID-19 Outcomes

124 million cases worldwide, with 2.73 million associated deaths. These are the numbers for COVID-19, a novel coronavirus pandemic which, over the past 12-15 months, has swept the globe. In the United States alone, there are 29.9 million cases with an associated 543,000 deaths. But as time has gone on, researchers have begun understanding more of how the virus works and what exacerbates it. According to Healio, data presented at the ENDO Annual Meeting shares that dysnatremia (abnormal sodium levels) increases the risk of mortality and ventilation for those hospitalized with COVID-19. Those with hypernatremia are at a slightly higher risk of dying than those with normal sodium levels, and those with hyponatremia are at a higher risk of requiring additional ventilation. See some of the presented data published in The Journal of Clinical Endocrinology & Metabolism.

The Research

During this study, researchers wanted to understand what role sodium levels played in COVID-19. The retrospective longitudinal study sourced data from all adults admitted to two specific hospitals during an 8-week period. Researchers used pathology and medical records, as well as information from discharge. Ultimately, researchers wanted to see how many patients died in the hospital and which patients required additional ventilation. 488 adults were included. Of these, the median age was 68, and approximately 277 patients were males. Prior to hospitalization, 5.1% (25 patients) already had hyponatremia.

Later, 5.3% (26 patients) were diagnosed with hypernatremia and 24.6% (120 patients) had hyponatremia. Researchers discovered that hyponatremia was not linked to mortality rates, though patients with hyponatremia did require more ventilation than their counterparts. Alternately, those with hypernatremia did not require as much ventilation but did have higher death rates. During hospitalization, rates of hyponatremia also fell while rates of hypernatremia rose.

While additional research is needed to understand the link between sodium and COVID-19 risk, the researchers believe this can hopefully direct doctors on some care at this point in time.


Hyponatremia is a form of dysnatremia which occurs when sodium levels in the blood are abnormally low. Because sodium is an electrolyte, it helps regulate water coming in and out of cells. But when sodium levels are diluted (and thus too low), water levels can cause cells to swell, causing a host of health problems. Hyponatremia can have many causes, including hormonal changes, severe dehydration, medication or ecstasy use, and drinking too much water. Other risk factors include being involved in intensive physical activities or being older. Symptoms may vary in severity. They include:

  • Nausea and vomiting
  • Confusion
  • Headache
  • Fatigue and/or lethargy
  • Muscle weakness, cramps, and spasms
  • Restlessness and irritability
  • Seizures
  • Coma

Learn more about hyponatremia.


Contrastingly, hypernatremia refers to when sodium levels in the blood are too high, especially compared to water content. Typically, hypernatremia is associated with dehydration. In many cases, those who develop hypernatremia are already hospitalized for other reasons. Because of this, many with this condition are elderly. Other causes include salt poisoning, inability to ingest enough water, diuretic use, extreme sweating, or diarrhea. At first, hypernatremia is mild, but should be treated quickly to address the imbalance.

Symptoms vary between adults and infants. In adults, symptoms include (but are not limited to):

  • Mental confusion
  • Muscle weakness and spasms
  • Nausea
  • Confusion
  • Restlessness
  • Lethargy
  • Brain shrinkage (only occurs in severe cases)

Alternately, symptoms of hypernatremia in infants include:

  • Insomnia
  • Lethargy
  • Rapid breathing
  • Muscle weakness
  • An extremely high-pitched cry
  • Coma and/or seizures

Learn more about hypernatremia.

Jessica Lynn

Jessica Lynn

Jessica Lynn has an educational background in writing and marketing. She firmly believes in the power of writing in amplifying voices, and looks forward to doing so for the rare disease community.

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