Changes In Serum Magnesium Levels Research Articles

Association between short-term changes in serum magnesium and in-hospital mortality following acute myocardial infarction: a cohort study based on the MIMIC database.

The association between short-term changes in serum magnesium level and risk of in-hospital mortality was investigated in patients with acute myocardial infarction (AMI). In this retrospective cohort study, data of 2,716 patients with AMI were extracted from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) database for 2001-2012. Univariate and multivariate Cox proportional hazards models were used to explore the association between serum magnesium level and short-term change and in-hospital mortality in patients with AMI. In addition, subgroups according to age, gender, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS-II) were also analysed. In total, 504 (18.6%) patients died in hospital. After adjusting for covariates, all AMI patients with high magnesium levels at ICU admission (HR=1.03, 95%CI: 0.83-1.27) or 48 hours after ICU admission (all p<0.05), or those demonstrating a change in magnesium level within the first 48 hours of ICU stay (all p<0.05) were shown to have a high risk of in-hospital mortality. Moreover, this correlation was retained irrespective of age, gender, SOFA score, and SAPS-II (allp<0.05). Serum magnesium levels at different time points after ICU admission and change in serum magnesium level during the first 48 hours were associated with in-hospital mortality in patients with AMI, indicating that clinical attention should be paid to short-term changes in serum magnesium levels regarding treatment adjustment, which may further reduce the risk of mortality.

Mo1523 RESPONSE CHANGES IN SERUM MAGNESIUM LEVELS IN PATIENTS WITH SEVERE ALCOHOL-ASSOCIATED HEPATITIS CORRESPOND WITH SEVERITY-ASSOCIATED PROGNOSTIC OUTCOMES

Mo1523 RESPONSE CHANGES IN SERUM MAGNESIUM LEVELS IN PATIENTS WITH SEVERE ALCOHOL-ASSOCIATED HEPATITIS CORRESPOND WITH SEVERITY-ASSOCIATED PROGNOSTIC OUTCOMES

Time-dependent changes in serum magnesium levels in patients receiving cetuximab with low baseline serum sodium levels.

Cetuximab causes electrolyte abnormalities, such as hypomagnesemia, hypokalemia, and hypocalcemia. However, little is known about the relationships between the onset of hypomagnesemia, patient background before administration, and time-dependent changes in serum magnesium levels. Therefore, we examined the patient backgrounds that influenced the onset of hypomagnesemia and the time-dependent changes in serum magnesium levels in patients receiving cetuximab. A retrospective study was performed to investigate patients with advanced or recurrent colorectal cancer or head and neck cancer, treated with a cetuximab regimen from 2012 to 2020 at Kindai University Nara Hospital. In total, 52 patients who met the inclusion criteria were enrolled in this study. The serum magnesium level was significantly lower in the hyponatremia before the administration group than in the non-hyponatremia group (p < 0.001). Univariate logistic regression analysis revealed that the baseline serum sodium levels (odds ratio [OR]: 0.741, 95% confidence interval [CI]: 0.588-0.934) and the combination of magnesium oxide tablet (OR: 0.997, 95% CI: 0.995-0.999) were one of the independent factors for hypomagnesemia. These results indicated that hyponatremia before administration may be an indicator of serum magnesium levels after administration of cetuximab. Cetuximab-induced hypomagnesemia may be predicted using baseline serum sodium levels, and hypomagnesemia may be prevented by administration of magnesium oxide tablets. Our findings provided new evidence for the management of serum magnesium levels in patients receiving cetuximab.

Alterations in Serum Magnesium Levels in Hyperbili-rubinemic Neonates Before and After Phototherapy

Background: Bilirubin binds to cell membrane phospholipids, including N-methyl D-aspartate receptor, and causes excessive activation that can lead to neurotoxic effects. Since magnesium is an important inhibitor of this receptor, a comparison can be made between the physiological effects of magnesium and the neurological effects of bilirubin. This study aimed to compare changes in serum magnesium levels before and after phototherapy in hyperbilirubinemic newborns.Methods: This retrospective cross-sectional study examined full-term newborns with hyperbilirubinemia. These newborns were admitted between 2012 and 2014 to the Neonatal Unit of Children’s Medical Center in Tehran, Iran. Based on the amount of bilirubin upon admission, participants were divided into three groups of mild (20 mg/dl). The total serum magnesium levels were measured before and 12-24 h after phototherapy.Results: A total of 143 newborns were included in this study. A significant difference was observed between serum magnesium levels before (2.42±0.46 mg/dl) and after (2.07±0.32 mg/dl) phototherapy (P<0.001). This difference was observed in all etiologies of icterus.Conclusion: The magnesium level decreased significantly after the completion of jaundice treatment for all causes of the condition. These findings raise the hypothesis that an increase in the level of extracellular magnesium is a defense mechanism that reduces the neurotoxic effects of bilirubin.

Lower Serum Magnesium Concentrations are associated With Specific Heavy Drinking Markers, Pro-Inflammatory Response and Early-Stage Alcohol-associated Liver Injury§.

Chronic heavy alcohol intake frequently causes liver inflammation/injury, and altered mineral metabolism may be involved in this liver pathology. In this study, we evaluated the association of heavy drinking, changes in serum magnesium levels and biochemical evidence of liver injury in alcohol-use-disorder (AUD) patients who had no clinical signs or symptoms of liver injury. We also aimed to identify any sex-based differences in patients with mild or no biochemical evidence of liver injury induced by heavy drinking. 114 heavy drinking alcohol-dependent (AD) female and male patients aged 21-65years without clinical manifestations of liver injury, who were admitted to an alcohol treatment program, were grouped by alanine aminotransaminase (ALT) levels: ≤ 40IU/L, as no liver injury (GR.1), and ALT>40IU/L as mild liver injury (GR.2). Patients were actively drinking until the day of admission. Comprehensive metabolic biochemistry results, fatty acid panel, serum magnesium and drinking history data were collected at admission; and study-specific measures were evaluated. In all AD patients, lower magnesium was significantly associated with the heavy drinking marker and heavy drinking days past 90days (HDD90). A lower serum magnesium concentration was observed in AD patients with mild liver injury. Females of both groups had mean levels of magnesium in the deficient range. A clinically significant drop in magnesium levels was observed only in the GR.2 (mild liver injury) male AD patients. Females showed a significant association between low magnesium levels and the ω6:ω3 polyunsaturated fatty acids (PUFAs) ratio. Specific heavy drinking markers showed an association with lower magnesium levels. Low serum magnesium levels are common in subjects with AUD and appear to be associated with the onset of liver injury.

Study of serum magnesium levels in stable chronic obstructive pulmonary disease and chronic obstructive pulmonary disease exacerbations

Introduction: When magnesium is deficient, the action of calcium is enhanced. In contrast, an excess of magnesium blocks calcium. These interactions are important to the respiratory patient because the intracellular influx of calcium causes bronchial smooth-muscle contraction. The possibility exists that magnesium deficiency contributes to pulmonary complications. Aim of this study to check whether acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with changes in serum magnesium levels. Methodology: 20 diagnosed with COPD- exacerbations and 20 with stable COPD were included in the study. The study was conducted for a period of 2 months to compare the serum magnesium levels in both groups. The samples were collected and the magnesium levels were evaluated by biochemical analysis. Results: At the end of the study 45% of the participants in the exacerbations group had serum magnesium less than 1.5 mg/dl whereas none of the participants of the stable group had magnesium values less than 1.5 mg/dl. This suggests a possible association between low serum magnesium levels and exacerbations of COPD. Conclusions: These findings indicate that pulmonary patients should be monitored routinely for magnesium deficiency. Keywords: Acute exacerbation of chronic obstructive pulmonary disease; Magnesium; Pulmonary function test

Association of Serum Magnesium Level with Odds of Prediabetes and Diabetes in a Southern Chinese Population: a Prospective Nested Case-Control Study.

Although emerging clinical evidence supports that magnesium deficiency is a risk factor for the development of type 2 diabetes, there are sparse studies concerning the dynamic change of serum magnesium with the risk of diabetes and its early stages. In this nested case-control study, we performed a 75-g oral glucose tolerance test or a standardized steamed bread meal test in 178 subjects with incident glucose metabolism impairment (33 with type 2 diabetes and 145 with prediabetes) and 178 matched controls at baseline and at 3-year follow-up and determined the associations between baseline serum magnesium levels as well as changes in serum magnesium levels at follow-up and odds of prediabetes and diabetes. After adjusting for potential confounders, the odds ratios of risk for prediabetes and type 2 diabetes in the highest quartile of serum magnesium levels were 0.22 (95% confidence intervals [CI] 0.10-0.49; p for trend <0.001) and 0.02 (95% CI 0.00-0.29; p for trend = 0.009), respectively, as compared with the lowest quartile. In addition, a significant decline in the serum magnesium level was detected in type 2 diabetes cases (p = 0.015) at 3years as compared with at baseline. These results suggest that a low magnesium level is an independent risk factor for prediabetes and type 2 diabetes, and that the reduction of serum magnesium is associated with type 2 diabetes in a southern Chinese population.

Changes in serum magnesium concentration after use of a proton pump inhibitor in patients undergoing percutaneous coronary intervention

BackgroundAlthough cross-sectional studies have suggested a relationship between proton pump inhibitor (PPI) use and hypomagnesemia, no large-scale cohort study has been conducted to date. Here, we examined the changes in serum magnesium levels in response to PPI use. We hypothesized that PPI use might change the serum magnesium concentration. MethodsOf the 2,892 patients hospitalized for percutaneous coronary intervention between January 2007 and May 2012, 1,076 patients with normal baseline (1.6–2.5mg/dL) and follow-up serum magnesium concentrations were enrolled. These patients were divided into two groups: the PPI group and the control group. ResultsThe mean follow-up period was 9.51±2.94 months. The incidence of hypomagnesemia (<1.6mg/dL) was 0.4% (3/834) in the PPI group and 0.4% (1/242) in the control group (P=0.904). The change in magnesium levels did not differ between the two groups, and this result was maintained in the analysis of covariance after adjusting for confounding factors (P=0.381). Moreover, magnesium levels did not significantly differ between the long-term (duration of use ≥12 months, n=71) and short-term PPI groups (duration of use <12 months, n=763), and the control group (n=242; P=0.620). The effect of PPI use on change in serum magnesium concentration was affected by the use of multiple diuretics (−0.01±0.25mg/dL; P=0.025), although a single diuretic use with PPI did not alter the change in magnesium level (0.12±0.27mg/dL). ConclusionChanges in magnesium levels might be subtle after PPI use in patients with normal baseline magnesium values.

Increase in Serum Magnesium Level in Haemodialysis Patients Receiving Sevelamer Hydrochloride

Clinical studies have shown that sevelamer hydrochloride improves lipid profiles and attenuates the progression of the cardiovascular calcifications in haemodialysis patients. It is known that both of these properties are associated with increased magnesium levels. The effect of sevelamer on serum magnesium level is not well documented. The aim of this study was to determine the effects of sevelamer treatment on serum magnesium in haemodialysis patients and to assess the association of magnesium levels with lipid profiles and intact parathyroid hormone (iPTH). Phosphate binders were discontinued during a two week washout period. Forty-seven patients, whose serum phosphate was greater than 6.0 mg/dl at the end of washout, received sevelamer hydrochloride for eight weeks. The patients were then washed off sevelamer for another two weeks. Mean serum phosphorus concentration declined from 7.5 +/- 1.3 to 6.4 +/- 1.2 mg/dl (P < 0.001), mean serum magnesium levels increased from 2.75 +/- 0.35 to 2.90 +/- 0.41 mg/dl (P < 0.001) and median serum iPTH levels decreased from 297 to 213 pg/ml (P=0.001) during the eight weeks of sevelamer treatment. After the two week post-treatment washout phosphorus levels increased to 7.3 +/- 1.3 mg/dl (P < 0.001), magnesium levels were reduced to 2.77 +/- 0.39 mg/dl (P < 0.001) and iPTH levels increased to 240 pg/ml (P=0.012). No change was observed in serum calcium levels during the sevelamer treatment period and the subsequent washout period. The mean decline in total and low density lipoprotein (LDL) cholesterol during sevelamer treatment was 16.3 and 28.3 (P < 0.001), respectively. The mean increase in high density lipoprotein (HDL) cholesterol and in apolipoprotein A1 was 2.9 +/- 5.8 mg/dl (P=0.004) and 6.8 +/- 11.1 mg/dl (P=0.001), respectively. Multivariate analysis showed that the rise in serum magnesium concentration significantly correlated with reductions in iPTH levels (r=-0.40, P=0.016), but did not have any significant correlation with the changes in lipid profiles. Our findings indicate that patients on haemodialysis receiving sevelamer have a significant increase in serum magnesium concentrations. This increase in serum magnesium is associated with reduction in iPTH levels. The changes in lipid profiles of these patients however are not related to changes in serum magnesium levels.

Renal handling of magnesium in transplanted children under cyclosporin A treatment.

We investigated the renal handling of magnesium in 12 transplanted children under cyclosporin A treatment during the early period after transplantation. We also studied 30 children treated with cyclosporin A 2 years after renal transplantation and compared the results with those of 22 children treated with azathioprine and prednisolone 2-4 years after transplantation. Twenty-two children with chronic renal failure and 10 healthy children served as controls. During the 1st week after transplantation, the mean serum magnesium level dropped to 0.54 +/- 0.14 mmol/l and was accompanied by a high fractional magnesium clearance. During this period two patients showed generalized convulsions. After magnesium substitution, serum levels increased gradually and normalized 4 months later. Fractional magnesium clearance remained slightly elevated due to lower glomerular filtration rates. One to four years after transplantation there were no statistically significant differences in serum levels, clearance, excretion and fractional clearance of magnesium between patients treated with cyclosporin A and those receiving azathioprine. There was a linear regression between magnesium clearance and creatinine clearance and an inverse exponential correlation between fractional magnesium clearance and creatinine clearance. We conclude that cyclosporin A treatment after transplantation has no major effect on the renal handling of magnesium in kidney transplants. The observed changes in serum magnesium levels and fractional clearance are probably due to tubular cell damage early after transplantation and to high doses of furosemide.

Diabetic Ketoacidosis-Reply

In Reply.— Dr Kumar and colleagues have drawn attention to two issues. Firstly, with respect to the trend to hypomagnesemia developing in patients during insulin therapy, the observations are interesting and informative. They would have been more informative if Dr Kumar and associates had been able to directly compare the changes in serum magnesium levels between the intermittent high-dose insulin therapy group with the constant intravenous insulin therapy group in the more recent communication by Piters et al, 1 rather than comparing these new values with those reported almost 20 years ago by Martin et al. 2 Secondly, Dr Kumar and associates have misinterpreted our conclusions. The management of each case of diabetic ketoacidosis requires close scrutiny and vigilance on an individual basis by the responsible physician. The execution of physicians' orders, irrespective of the method used to treat diabetic ketoacidosis, continues to be performed by the nursing staff. We

Bone magnesium pools in uremia.

Bone magnesium pools were studied in vitro in bone specimens obtained from control subjects, from patients with chronic renal failure before and after renal transplantation, and in a patient with chronic hypomagnesemia. 30% of bone magnesium is in a surface limited pool present either within the hydration shell or else on the crystal surface. The larger fraction of bone magnesium was shown not to be associated with bone matrix but rather to be an integral part of the bone crystal. With incineration this pool was mobilized at the same temperature that sudden enlargement of bone crystal size occurred. It is suggested that heating causes surface calcium to displace magnesium from the apatite crystal. Both magnesium pools are increased in patients with chronic renal failure. The major factor determining magnesium concentration in bone would appear to be the serum magnesium level. Following renal transplantation, in association with the fall in serum magnesium, surface magnesium was within the normal range; whereas, residual magnesium was not different from the other urenic bones. Both magnesium pools were significantly reduced in a patient with chronic hypomagnesemia. The in vitro studies would suggest that surface magnesium should rapidly reflect changes in serum magnesium levels, whereas, the deeper magnesium pool is probably deposited at time of bone formation with mobilization being dependent upon the resorptive processes. Since magnesium can influence crystal size and stability it seems possible that excess bone magnesium may play a role in renal osteodystrophy.

Changes in Serum Magnesium Levels of Ruminants, as Influenced by Abrupt Changes in the Composition of the Diet Effect of Oral Administration of Various Inorganic and Organic Compounds on the Serum-Magnesium Level

During a period of four years in succession samples of grass from tetany prone pastures, topdressed with large amounts of amraon-sulphate and potassiumsulphate, have been analysed throughout the tetany season each year, and the results have been compared with the analytical data obtained from corresponding samples of grass collected from normally dressed pastures. The content of Mg and Ca and the feed unit value of the tetany prone grass differed very little from the normal. The protein content, however, was exceptionally high, and rather great differences were found in the content of P, S, K, Na and the trace elements. Several feeding experiments have been carried out in order to test the hypomagnesaemic and/or the tetanygenic effect of these compounds as dietary supplements to ruminants. The feeding was performed under exact daily control and the experiments were supported by daily serum mineral analyses. Experiments carried out with diets containing protein and feed units in the same ratio as found in the highly topdressed pasture grass, proved that this unbalanced ratio undoubtedly played an important role in the hypomagnesaemia inducing effect of the grass. As long as the fodder was given in amounts high enough to cover the feed units requirements, the level of serum Mg remained unchanged. The falling tendency of the serum Mg level was, however, evident when the fodder rations were reduced to amounts insufficient to cover the feed unit requirements ot the cows — a situation often met with for shorter periods during pasturing. Hypomagnesaemia was produced within 3–4 days, whereas a similar reduction of a normally balanced fodder to cows had no serum Mg reducing effect in the course of twelve days. Of other factors coming into play, especially K2HPO4, Na2HPO4, K2SO4 and Na2SO4 proved to influence the serum mineral balance. Oral applications of large doses of these substances to healthy sheep, produced neither pronounced hypomagnesaemia nor tetany. The initial drop in the levels of serum Mg and particularly serum Ca were, however, so remarkable that tetany very probably would have been provoked if the animals had been in a hypomagnesaemic state when the experiment started. Experiments and results have been closely discussed. The conclusion has been drawn that the tetany prone effect of the heavily ammonsulphate dressed pastures could not possibly be conditioned by one single factor in the grass. A more possible explanation seems to be an unpropitious interaction of more active compounds present at the same time: The first step in the development of the disorder, i. e. the hypomagnesaemic condition, seems principally to be due to the unproportionately high content of protein in relation to the feed unit value of the grass. Owing to the fact that the quantity of dietary protein is in excess even if the feed unit content does not cover the theoretical requirements, the milk production remains high and the cows are hampered in their efforts to accomodate to those reductions in food intake unevitably happening to occur on pasture. The next step, the convulsion of tetany, however, depends upon other, co-operating factors able to disturb the Ca-balance at the very moment when the serum Mg is already low. According to the serum Mg- and Ca-reducing effect brought about by diets supplemented with alkaliphosphates and -sulphates, the author incline to the view that the extremely high content of P, S, K and to some extent also of Na found in the tetany prone pasture grass, may be the background for this effect of the grass. Temperature, rainfall and other environmental factors have also been taken into consideration as influencing the appetite and the absorptioncoefficient.