hypomagnesemia in critically ill patients
DESCRIPTION
importance of Magnesium levels on the critically ill patients and in ICUTRANSCRIPT
HYPOMAGNESEMIA IN CRITICALLY ILL MEDICAL PATIENTS
CS Limaye, VA Londhey, MY Nadkar, NE Borges FROM JAPI JAN 2011
MODERATOR-DR. AJEET KR. CHAURASIYA
PRESENTED BY
VINEET MISHRA
Magnesium50% to 60% contained in bone
4TH most common cation in the body
Coenzyme in metabolism of protein and
carbohydrates
Factors that regulate calcium balance appear
to influence magnesium balance
Acts directly on myoneural junction
Important for normal cardiac function
Low serum Mg caused byProlonged fasting or starvation
Shift: Pancreatitis, Insulin administration , Post-
parathyroidectomy
Chronic alcoholism
Fluid loss from gastrointestinal tract
Prolonged parenteral nutrition without
supplementation
Diuretics, aminoglycosides, cisplatinum,
amphotericin
Manifestations
Tremors, tetany , ↑ reflexes, paresthesias of feet
and legs, convulsions
Positive Babinski , Chvostek and Trousseau signs
Personality changes with agitation, depression or
confusion, hallucinations
ECG changes (tall peaked , flat or inverted T
waves ; ST depression , U waves, voltage loss ,
wide QRS and prolonged PR)
SIGNS EXCESS DEFICIENCY
Magnesium (Mg) Hypermagnesaemia
Loss of deep tendon reflexes (DTRs)
Depression of CNS
Depression of neuromuscular function
Hypomagnesaemia
Hyperactive DTRs
CNS changes
BACKGROUNDHypomagnesaemia is an important but
underdiagnosed electrolyte abnormality in critically ill patients.
There are many studies to find the prevalence of hypomagnesaemia and its effects on mortality and morbidity in these patients
Studies have been carried out in intensive care units.
in respiratory intensive care unit critically ill cancer patient
AIMS AND OBJECTIVES
• To study serum magnesium levels in critically ill patients
• To correlate serum magnesium levels with patient outcome.
• To identify the primary medical conditions associated with abnormalities of serum magnesium
• To identify the factors predisposing or contributing to hypomagnesaemia in critically ill patients admitted in a medical intensive care unit
• To detect other electrolyte abnormalities associated with hypomagnesemia
PARAMETERS
Length of stay in MICU
Need for ventilatory support
Duration of ventilatory support
APACHE score
Mortality
METHODOLOGYProspective observational study was carried out in
the Medical Intensive Care Unit(from April 2004 to
May 2005)
Hundred patients admitted to the MICU for critical
illnesses were INCLUDED in the study
Patients who had received magnesium prior to
transfer to MICU were EXCLUDED
Blood sample was collected for estimation of serum
total magnesium levels
History and clinical findings were noted
Hematological, biochemical and radiological
investigations were performed
APACHE score was calculated for each patient on the
day of admission
Serum total magnesium level (1.7 to 2.4 mg/dl) was
determined by colorimetric method using Titan yellow
Normal deviate (z) test was applied for quantitative
data and chi-square test was applied for qualitative
data
CRITICAL DISEASES• Severe infections like
complicated malaria,leptospirosis, tetanus,
urinary tract infections, cellulitis, meningitis,
pneumonia, tuberculosis and mucormycosis.
• Hepatic failure
• Acute renal failure
• Chronic renal failure
• Respiratory failure
Congestive cardiac failure
Cerebrovascular accident
Poisonings including Organophosphate compounds
Snake bite
Acute pancreatitis
Guillain-Barre syndrome
Malignancy
Status epilepticus and
Diabetic ketoacidosis
Mortality
Ventilator need
Ventilator days
MICU stay
APACHE
Hypocalcemia
Hypoalbuminemia
Hypokalemia
Sepsis
DM
Alcoholism
0 10 20 30 40 50 60 70 80 90
Study result
NormoHypo
Representational values
CONCLUSION
HYPOMAGNESEMIA AFFECTED/ASSOCIATED WITH-
HYPOCALCEMIA
HYPOALBUMINEMIA
VENTILATOR NEED
ON VENTILATOR DURATION
SEPSIS
DIABETES MELLITUS
MORTALITY
CONCLUSION CONTD. . . . . HYPOMAGNESEMIA NOT AFFECTED/ASSOCIATED WITH-
MICU STAY
APACHE II SCORE
HYPOKALEMIA
ALCOHOLISM (CHRONIC)
SUMMARYHypomagnesaemia is a common electrolyte
imbalance in the critically ill patients.Whether hypomagnesaemia directly
contributes to cellular alterations leading to increased mortality, morbidity and poor patient outcome in critically ill patients or it is just a marker of critical illness is not clear.
Hypomagnesaemia is associated with higher mortality rate in critically ill patients and is also associated with more frequent and more prolonged ventilatory support.
It was seen in this study that hypomagnesaemia is frequently associated with sepsis and diabetes mellitus.
Although there was a high incidence of hypomagnesaemia in the present study, its correction after magnesium supplementation was not included as a part of the study.
The potential benefit of magnesium supplementation to prevent or correct hypomagnesaemia in critically ill patients requires further study.
MAGNESIUM ESTIMATIONSpecimen: non-hemolyzed serum or lithium heparin
plasma used. EDTA and citrate bind to the Mg.
24hr urine may be used and should be acidified to avoid Ppt.
Colorimetric method/photometric[TITAN YELLOW]: Mg binds to calmagite, formazen dye and methylthymol blue to form a chromogen that is measure at 532- 600nm.
Ca2+ should be eliminated from the sample
AAS- absorbance at 285.2nm
ISE- free Mg with neutral carrier inonophores
TAKE HOME MESSAGE
Hypomagnesaemia is NOT A RARE electrolyte abnormality in critically ill patients.Hypomagnesemia should NOT be misdiagnosed as Hypokalemia.It should be ordered with Na, K and Ca serum levels.REMEMBER HYPOMAGNESEMIA TOO !!