A STUDY OF HYPOMAGNESEMIA IN PATIENTS ADMITTED IN MEDICAL ICU AND ITS CORRELATION WITH FINAL OUTCOME

Harshil Gosalia; Om  Patel; Nilesh M  Doctor; Hemant  Shah

doi:10.55489/njmr.13012023939

Authors

Harshil Gosalia Surat Municipal Institute of Medical Education and Research (SMIMER)
Om Patel Surat Municipal Institute of Medical Education and Research, Surat, India
Nilesh M Doctor Surat Municipal Institute of Medical Education and Research, Surat, India
Hemant Shah Surat Municipal Institute of Medical Education and Research, Surat, India

DOI:

https://doi.org/10.55489/njmr.13012023939

Keywords:

APACHE II – Acute Physiologic Assessment and Chronic Health Evaluation II, DM – Diabetes mellitus, HTN – Hypertension, ICU –Intensive Care Unit, Mg 2– Magnesium, K – Potassium, Na – Sodium

Abstract

Introduction: Magnesium is second most common intracellular cation found in the human body that is required as cofactor in numerous enzymatic reactions, important for smooth functioning of cardiac and neurological systems. Magnesium deficiency is a condition that is often overlooked in critically ill patients. Magnesium deficiency is linked with risk of electrolyte imbalance, difficulty to wean off ventilator, sudden cardiac death and ultimately poorer outcome of critically ills patients.

Objective: To assess prevalence of magnesium deficiency in critically ill patients admitted to Medical ICU and its association with requirement & duration of mechanical ventilation, ICU stay, APACHE-II & mortality.

Methods: This Prospective descriptive study was conducted on 69 critically ill patients admitted in medical ICU of Department of Medicine in Tertiary health care center of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Serum magnesium level of admitted patients were collected and entered in spreadsheet and Final analysis has been done with the help of Open EPI and SPSS software.

Results: It was concluded that patients having hypomagnesemia were at increased risk of electrolyte abnormalities, longer ventilatory support, longer hospital and ultimately poorer outcome stay as compared to patients who had normal magnesium levels.

Conclusion: Magnesium remain an important but often side-lined cation in the critically ill patient. However, Hypomagnesemia is a repeated finding seen in critically ill patients and is significantly associated with a higher mortality rate and more frequent need for mechanical ventilation.

References

Maguire ME, Cowan JA. Magnesium chemistry and biochemistry. Biometals. 2002;15:203-210. Doi: https://doi.org/10.1023/A:1016058229972 PMid:12206387

Wacker W. Magnesium and Man. Cambridge, MA: Havard University Press; 1980. pp. 1-184. Doi: https://doi.org/10.4159/harvard.9780674366374

Grober U., Schmidt J., Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7:8199-8226. Doi: https://doi.org/10.3390/nu7095388 PMid:26404370 PMCid:PMC4586582

Vink R., Nechifor M. Magnesium in the Central Nervous System. University of Adelaide Press; Adelaide, Australia: 2011. p. 342. Doi: https://doi.org/10.1017/UPO9780987073051

Magnesium deficiency in critically ill patients by A Arnold 1, J Tovey, P Mangat, W Penny, S Jacobs Doi: https://doi.org/10.1111/j.1365-2044.1995.tb04556.x PMid:7717483

Whang R, Oei TO, Aikawa JK, Watanabe A, Vannatta J, Fryer A, et al. Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia. Arch Intern Med. 1984;144:1794-1796. Doi: https://doi.org/10.1001/archinte.144.9.1794 PMid:6476998

2. Wong ET, Rude RK, Singer FR, Shaw ST., Jr A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol. 1983;79:348-352. Doi: https://doi.org/10.1093/ajcp/79.3.348 PMid:6829504

3. Hayes JP, Ryan MF, Brazil N, Riordan TO, Walsh JB, Coak-ley D. Serum hypomagnesaemia in an elderly day-hospital population. Ir Med J. 1989;82:117-119

Gullestad L, Dolva LO, Waage A, Falch D, Fagerthun H, Kjekshus J. Magnesium deficiency diagnosed by an intrave-nous loading test. Scand J Clin Lab Invest. 1992;52:245-253. Doi: https://doi.org/10.3109/00365519209088355 PMid:1439510

APACHE II: a severity of disease classification system by W A Knaus, E A Draper, D P Wagner, J E Zimmerman PMID: 3928249

Kumar S, Jain S, Agrawal S, Honmode A. Impact of serum magnesium levels in critically ill elderly patients-A study in a rural teaching hospital. Journal of Clinical Gerontology and Geriatrics. 2016 Sep 1;7(3):104-8. Doi: https://doi.org/10.1016/j.jcgg.2016.04.002

Chaudhari S. Significance of Serum Magnesium Levels In Critically Ill-Patients. Journal of Dental and Medical Scienc-es.2017;(16)11:79-81

Ugaragol PG. A study of serum magnesium level in critically ill patients. International Journal of Biomedical and Advance Re-search 2017; 8(12): 446-449.

Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. The Journal of the As-sociation of Physicians of India. 2011 Jan 1;59:19-22.

Sudha R, Bharanidharan S. serum magnesium in relation to apache iv score and outcome in critically ill patients. Interna-tional Journal of Current Research and Review. 2015 Jul 1;7(13):58.

Pannem RB, Munamala CSR. An observational study on ef-fects of hypomagnesemia among critically ill patients at a tertiary care hospital. Int J Adv Med 2018;5:1347-51. Doi: https://doi.org/10.18203/2349-3933.ijam20184254

Zafar MS, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill-patients. International Journal of Applied and Basic Medical Research. 2014 Jan;4(1):34. Doi: https://doi.org/10.4103/2229-516X.125690 PMid:24600576 PMCid:PMC3931212

Charles BS, Menon I, Girish TS, Cherian AM. Hypomagnesemia in the ICU-does correction matter? The Journal of the Association of Physicians of India. 2016 Nov 1;64(11):15-9.