Original Article

Is Intra-Cellular Magnesium Concentration Correlate with Morbidity and Mortality in Critically Ill Patients? A Cross-Sectional Study

Abstract

Backgrounds: Hypomagnesemia is a common electrolyte disturbance among critically ill patient which is associated with increased morbidity and mortality. In this study, correlations between serum and intra-cellular magnesium concentrations at the time of intensive care unit (ICU) admission with ICU complications and mortality were evaluated.
Methods: This cross-sectional study included 70 consecutive adult patients admitted to the intensive care unit of a tertiary referral teaching hospital during a six-month period. Serum and intra-cellular magnesium levels were measured on admission. Clinical information, morbidity, and mortality were followed and recorded during ICU stay until discharge or death.
Results: On admission, 37.14% of patients suffered hypomagnesemia. Low intra-cellular magnesium level was observed in 44.28% of patients. Cardiovascular complications and mortality were significantly higher in patients with lower serum and intra-cellular magnesium levels when compared to patients with normal levels (P < 0.05). There was a significant correlation between serum magnesium level on ICU admission and Acute Physiology and Chronic Health Evaluation (APACHE II) score (r = ˗0.39, P < 0.001).
Conclusion: Particular attention should be reserved to possible prognostic and therapeutic consequences of magnesium depletion in critically ill patients. Magnesium deficiency was associated with a higher APACHE II score on admission, higher cardiovascular complications, and increased mortality.

1. Glasdam SM, Glasdam S, Peters GH. The Importance of Magnesium in the Human Body: A Systematic Literature Review. Adv Clin Chem 2016;73:169-93.
2. Tam M, Gomez S, Gonzalez-Gross M, Marcos A. Possible roles of magnesium on the immune system. Eur J Clin Nutr 2003;57(10):1193-7.
3. Efstratiadis G, Sarigianni M, Gougourelas I. Hypomagnesemia and cardiovascular system. Hippokratia 2006;10(4):147-52.
4. Shechter M. Magnesium and cardiovascular system. Magnes Res 2010;23(2):60-72.
5. Landon RA, Young EA. Role of magnesium in regulation of lung function. J Am Diet Assoc 1993;93(6):674-7.
6. Lee JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press 2010;8(2):72-81.
7. Chernow B, Bamberger S, Stoiko M, et al. Hypomagnesemia in patients in postoperative intensive care. Chest 1989;95(2):391-7.
8. Ryzen E, Wagers PW, Singer FR, Rude RK. Magnesium deficiency in a medical ICU population. Crit Care Med 1985;13(1):19-21.
9. 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;7(3):104-108.
10. Soliman HM, Mercan D, Lobo SS, Melot C, Vincent JL. Development of ionized hypomagnesemia is associated with higher mortality rates. Crit Care Med 2003;31(4):1082-7.
11. Upala S, Jaruvongvanich V, Wijarnpreecha K, Sanguankeo A. Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis. QJM 2016;109(7):453-9.
12. Jiang P, Lv Q, Lai T, Xu F. Does Hypomagnesemia Impact on the Outcome of Patients Admitted to the Intensive Care Unit? A Systematic Review and Meta-Analysis. Shock 2017;47(3):288-95.
13. Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India 2011;59:19-22.
14. Dawson JB, Heaton EW. The determination of magnesium in biological materials by atomic absorption spectrophotometry. Biochem J 1961;80(1):99-106.
15. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128-40.
16. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13(10):606-608.
17. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012(4);120:c179–84.
18. Panahi Y, Mojtahedzadeh M, Najafi A, et al. The role of magnesium sulfate in the intensive care unit. EXCLI J 2017;16:464-82.
19. Mousavi SA, Salimi S, Rezai M. Serum magnesium level impact on the outcome of patients admitted to the intensive care unit. Tanaffos 2010;9(4):28-33.
20. Safavi M, Honarmand A. Admission hypomagnesemia—impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol 2007;19(3):645-60.
21. Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med 1993;21(2):203-9.
22. Chen M, Sun R, Hu B. The influence of serum magnesium level on the prognosis of critically ill patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015;27(3):213-7.
23. Kiran HS, Sriramachandrudu A, Murthy KS, Gowdappa HB. Serum Magnesium levels in critically ill patients–A Prospective Study. International Journal of Scientific Study 2015;3(7):241-4.
24. Escuela MP, Guerra M, Anon JM, et al. Total and ionized serum magnesium in critically ill patients. Intensive Care Med 2005;31(1):151-6.
25. Guérin C, Cousin C, Mignot F, Manchon M, Fournier G. Serum and erythrocyte magnesium in critically ill patients. Intensive Care Med 1996;22(8):724-7.
26. Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients 2015;7(9):8199-226.
27. Del Gobbo LC, Imamura F, Wu JH, de Oliveira Otto MC, Chiuve SE, Mozaffarian D. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2013;98(1):160-73.
28. Fazekas T, Scherlag BJ, Vos M, Wellens HJ, Lazzara R. Magnesium and the heart: antiarrhythmic therapy with magnesium. Clin Cardiol 1993;16(11):768-74.
29. Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in Critically Ill Sepsis Patients. J Clin Med Res 2015;7(12):911-8.
30. Elin RJ, Hosseini JM, Gill JR Jr. Erythrocyte and mononuclear blood cell magnesium concentrations are normal in hypomagnesemic patients with chronic renal magnesium wasting. J Am Coll Nutr 1994;13(5):463-6.
Files
IssueVol 8, No 3 (Summer 2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v8i3.4544
Keywords
Intensive Care Units Magnesium Deficiency Intracellular Space Critical Illness Morbidity Mortality
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Heidari Z, Abdollahi A, Khalili H. Is Intra-Cellular Magnesium Concentration Correlate with Morbidity and Mortality in Critically Ill Patients? A Cross-Sectional Study. J Pharm Care. 2020;8(3):110-115.