International Journal of Research in Medical Sciences

Goli G et al. Int J Res Med Sci. 2016 Aug;4(8):3324-3327

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162287
Research Article

Study of serum electrolytes in acute exacerbation of chronic

obstructive pulmonary disease patients
Gnaneshwar Goli, Rajender Mukka, Sunil Sairi*

Department of Pulmonology, CAIMS, Karimnagar, Telangana, India

Received: 07 June 2016

Accepted: 01 July 2016

*Correspondence:
Dr. Sunil Sairi,
E-mail: sunil.dr85@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant
morbidity, mortality and decreased quality of life. Due to lack of awareness of precipitating factors and predictors of
prognosis in acute exacerbation of COPD in developing countries by most treating physicians, often leads to fatal
outcomes. Aim of the study was to study of serum electrolytes in acute exacerbation of COPD Patients.
Methods: In our study, we assessed the levels of serum sodium and potassium in subjects with acute exacerbation of
COPD and their healthy controls.
Results: We found a significantly low level of serum sodium (132±5.65Meq/lit) and potassium (3.29±0.96 Meq/lit))
in subjects with acute exacerbation of COPD than their healthy controls (Na+ =140±2.28 Meq/lit and K+ = 4.51±0.02
Meq/lit (p<0.05).
Conclusions: Our study findings suggest that, serum sodium and potassium levels may get deranged in subjects with
acute exacerbations of COPD which should be routinely checked for to avoid fatal outcomes.

Keywords: COPD, SIADH, AVP, Hyponatremia, Hypokalemia

INTRODUCTION In addition to the financial burden required to care for

these patients, other ‘costs’ such as days missed from
Chronic obstructive pulmonary disease (COPD) affects work and severe limitation in quality of life (QOL) are
large number of patients and is associated with significant important features of this condtion.5,6 Although
morbidity, disability and mortality.1,2 COPD is respiratory infections are assumed to be the main risk
complicated by frequent and recurrent acute factors for exacerbation of COPD, other conditions,
exacerbations ,which are associated with enormous health including industrial pollutants, allergens, sedatives,
care expenditures and high morbidity. congestive heart failure, and pulmonary embolism, have
been identified.3,4,7,8
An exacerbation is of COPD is defined as ‘event in the
natural course of the disease characterised by a change in The cause of an exacerbation of COPD may be
the baseline dyspnea, cough and/or sputum and beyond multifactorial, so that viral infection or levels of air
normal day to day variations ,that is acute in onset and pollution may exacerbate the existing inflammation in the
may warrant a change in regular medication in a patient airways, which, in turn, may predispose to secondary
with underlying COPD.3,4 Exacerbations are categorized bacterial infections.
in terms of either clinical presentations (number of
symptoms) or healthcare utilization.3,4 There may be a number of metabolic derangements
arising out of the disease process or as a consequence of
the therapy of COPD (i.e. beta2 agonists and steroids)

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instituted can cause hyponatremia, hypokalemia, Table 1: Age and sex distribution of study and control
hyperbilirubinemia, elevated transaminases, elevated groups.
blood urea and serum creatinine etc Mohan et al.9 Though
most of these features are correctable, very often they are Groups Age (years) Males females
missed or confuse the diagnosis. COPD 61.22±11.45 48 14
Controls 61±9.5 15 5
Thus simple overlooking of the coexistent metabolic
abnormalities may contribute to a great morbidity and
Table 2: Serum electrolytes in both study and control
mortality. Thus early recognition and prompt correction
groups.
of these metabolic abnormalities are crucial. Aim of
study was to study of serum electrolytes in acute
exacerbation of COPD Patients. Groups Serum sodium Serum potassium
(Meq/l) (Meq/l)
METHODS COPD 132±5.65 3.29±0.96
Controls 140±2.28 4.51±0.02
This prospective Study was conducted on 62 patients of
acute exacerbation of COPD admitted in the the DISCUSSION
Department of Pulmonary Medicine at Chalmeda Anand
Rao Institute of Medical sciences, Karimnagar, In a case of acute exacerbation of COPD, it has been
Telangana. Age-sex matched twenty healthy community observed that besides the signs of acute infection, there
controls were taken. Institutional Ethical Committee may be number of co-morbid conditions like type II
approval and informed consent from the subjects or their respiratory failure and carbon dioxide narcosis, metabolic
legal relatives were taken. abnormalities such as dyselectrolytemia, uremia and liver
function abnormalities. Though most of the abnormalities
Inclusion criteria are correctable, attempt is not made to correct either due
to overlooking or due to lack of lab facility for 24 hrs
Diagnosed cases of COPD with exacerbation of monitoring.
symptoms.
In our study, we measured serum electrolytes (sodium
Exclusion criteria and potassium) in COPD exacerbation patients.We found
a significantly low level of serum sodium and potassium
Other causes of dyselectrolytemia were excluded from in the COPD patients (132±5.65 Meq/l and 3.29±0.96
the study like chronic renal failure, diabetic ketoacidosis, Meq/l respectively) than that of the healthy controls
adrenocortical insufficiency, cerebral salt wasting. (140±2.28 Meq/l and 4.51±0.02/ Meq/l respectively) (p
value <0.05 in each case). Patients with COPD are
Fasting blood samples from all the subjects were susceptible to hyponatremia for a number of reasons like
collected for the estimation of serum electrolytes like development or worsening of hypoxia, hypercapnia and
sodium and potassium in auto analyzer. Data were respiratory acidosis and right side heart failure with
analyzed by SPSS Microsoft Excel software. Significance development of lower limb edema, renal insufficiency,
of differences of average sodium and potassium levels in use of diuretics, SIADH (Syndrome of Inappropriate
two groups were evaluated statistically using Student’s’ Antidiuretic Hormone Synthesis), malnutrition, and poor
test. (p value <0.05 was considered to be significant). intake during acute exacerbations are common
contributing factors in such patients. Activation of the
RESULTS renin angiotensin aldosterone system and inappropriately
elevated plasma arginine vasopressin (AVP) in COPD
Total 62 patients of COPD, 48 were males and 14 were may all these factors aggravate the electrolyte imbalance
females. And out of 20 age- sex matched healthy controls during acute exacerbation of COPD ( Bauer et al, Vally et
15 were males and 5 were females. al, Das et al).10-12

Subjects of COPD were in the age range of 50-75 years, This is in agreement with the study by Das et al, who
average age of presentation being 61.22±11.45 years. In measured the serum K+ and Na+ in 64 patients with acute
the control group, subjects were in the age range of 50- exacerbation of COPD and compared the results with 20
75 years, average age being 61±9.5 years. healthy volunteers.12 They reported a significant decrease
in serum Na+ and K+ in COPD patients (133±6.86
Average serum sodium and potassium levels in COPD mEq/lit, 3.39±0.96 mEq/lit respectively) than in normal
patients were 132±5.65 meq/lit and 3.29 ± 0.96 meq/lit controls (142±2.28 mEq/lit, 4.52±0.02 mEq/lit
respectively and the levels in the control group were respectively, p<0.05). Also, in the study of Teranzo et al
140±2.28 mEq/lit and 4.51±0.02 meq/lit respectively. All Sixty-seven consecutive patients who were hospitalized
the data are summarized in Table1 and 2. for hypercapnic COPD exacerbation, Hyponatremia
occurred in 11 patients.13 hyponatremia with

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 Goli G et al. Int J Res Med Sci. 2016 Aug;4(8):3324-3327

hypochloremia and hypokalemia occurred in 10 patients, poor outcome in patients of COPD. It may lead to central
and hypochloremia occurred in 7 patients. nervous system dysfunction; confusion, convulsions,
coma, reversible cardiac conduction defect, secondary
Alcindo et al, studied the relative frequency of renal insufficiency even death (Suri et al; Porcel et
hypomagnesaemia and other electrolyte disorders in al).20,21 Therefore, hyponatremia should be meticulously
patients with chronic stable COPD patients taking inhaled searched for in every patient with acute exacerbation of
b2 agonists and inhaled steroids.14 Hypomagnesaemia COPD and should be actively corrected at the earliest.
reported in 27% of patients while hypocalcaemia,
hypokalemia and hyponatremia reported in 52%, 4.2% Hypokalemia may be another electrolyte abnormality in
and 2.8% of patients respectively. the subjects with COPD. It may be present independently
or concomitantly with hyponatremia. In our studythere
Beta-2 agonists whether inhaled like formetrol and was a significantly low level of serum potassium in
salbutamol or oral like salbutamol or bumbetrol in COPD patients than the healthy controls. Hypokalemia in
addition to oral sustained released theophylline, are the COPD may be attributed to respiratory acidosis and
main stay treatment in stable COPD. Unfortunately, all metabolic alkalosis or long standing steroid therapy Saini
these treatments have been proved to cause some et al.22 Use of beta 2-adrenoceptor agonist like salbutamol
electrolyte disorders in patients with bronchial asthma may also contribute to hypokalemia in COPD patients
and COPD. (Yang et al).15 (Yang et al).15 Moreover, acute respiratory failure
associated with hypokalemia was found to have a high
Comparing COPD patients with electrolyte disorders and mortality rate among the COPD patients (Hussain et al).23
those without any electrolyte imbalance on admission, This may be attributed to cardiac arrhythmias or
there was a significant decrease in PH, PaO2 and oxygen hampered nerve-muscle conduction. So, it appears from
saturation in patients with electrolyte disorders, while our study that hypokalemia may be a common associated
there was a significant increase in PaCo2. This means that finding in the subjects with COPD that should be
patients with electrolyte disorders, suffer from further corrected promptly to avoid fatal outcomes.
deterioration in arterial blood gases than other group
without any electrolyte disorders. CONCLUSION

Hypoxemia, that is worsen during acute exacerbation of In the stable COPD patients there are abnormal serum
COPD, is reported to induce depletion of intracellular Mg electrolytes like sodium and potassium levels, they may
ions. Since the Mg ion is involved in muscle contraction get further deranged in subjects with acute exacerbation
and in the maintenance of muscle tonus, a reduction in of COPD.Thus serum electrolyes level should be
Mg ion levels in patients with chronic airflow limitation monitored routinely in these patients and an attempt
might represent one more factor that is detrimental to should be made to correct them at the earliest to avoid
respiratory function or to the recovery of such function, poor outcomes.
since low levels of Mg induce muscle fatigue (Musch et
al).16 Also, respiratory acidosis with metabolic alkalosis ( Funding: No funding sources
due to renal compensation) in COPD patients with Conflict of interest: None declared
chronic hypercapnia is the usual cause of Hypochloremia Ethical approval: The study was approved by the
in those patients (Teranzo 2012).13 So, patients with Institutional Ethics Committee
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