Hypomagnesemic Group Research Articles

Serum Magnesium Levels in Patients Admitted to Intensive Care Unit and its Association with Sequential Organ Failure Assessment Score – A Cross-sectional Observational Study

Abstract Background: Magnesium deficiency has been reported in 20%–65% of patients in an intensive care unit (ICU) setting. They have mortality rates 2–3 times higher and prolonged hospitalization compared with those who have normal serum Mg levels. Objective: The objective of the study was to study serum magnesium levels in patients admitted to ICU and its association with sequential organ failure assessment (SOFA) score. Materials and Methods: A hospital-based cross-sectional study was carried out among 100 patients admitted to ICU. Detailed history, thorough physical examination, serum magnesium measurement, and routine investigations were performed. Based on serum magnesium levels, patients were divided into three groups: hypomagnesemia (<1.7 mg/dL), normomagnesemia (1.7–2.4 mg/dL), and hypermagnesemia (>2.4 mg/dL). SOFA score was calculated within 24 h of ICU admission. Results: Majority were male (65%). Majority were 41–60 years old (46%). Magnesium levels ranged from 1.0 mg/dL to 3.7 mg/dL, with a mean of 1.79 ± 0.59. The mean value of magnesium in the hypomagnesemia group was 1.225 ± 0.117, in the normomagnesemia group was 1.98 ± 0.2, and in the hypermagnesemia group was 2.96 ± 0.32. The mean SOFA score was significantly higher in patients with hypomagnesemia compared to patients with normomagnesemia and patients with hypermagnesemia (P < 0.05). The incidence of hypomagnesemia was 57.6% in patients with diabetes mellitus compared to 32.8% in those without diabetes. This difference was found to be statistically significant (P < 0.05). The odds of being diabetic in those with hypomagnesemia were 2.746 times more than those without hypomagnesemia. Conclusions: This study highlights the magnitude of magnesium disturbances on admission in critically ill patients admitted to ICU in the given settings. Hypomagnesemia is associated with a high SOFA score.

Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study.

Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.

Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults

ABSTRACT Objectives The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). Methods 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5–1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. Results 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. Conclusion Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.

Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study

BackgroundSepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities.MethodsThis retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission.ResultsAmong 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6–2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60–4.76; P < 0.001).ConclusionsHypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.

Association of Hypomagnesemia With Diabetic Complications.

The study aimed to study the association of hypomagnesemia with diabetic complications in type 2 diabetics. This cross-sectional study, conducted at a Ghurki Trust Teaching Hospital, spanned from January to June 2023 and included 100 randomly selected diabetic patients aged 30-70. With institutional board approval and informed consent, the study focused on assessing hypomagnesemia, using a standard level of below 1.6 mg/dL, ensuring participant confidentiality and privacy. Data collected through physical assessments were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States), including descriptive statistics, analysis of variance (ANOVA), and paired t-test. A total of 100 diabetic admitted patients were randomly selected for the study ages from30 to 70 years irrespective of their gender. The mean age of the participants was 53.86±9.74 years. The mean HbA1c of the participants was 8.7±2.32. Forty-eight percent of them had HbA1c less than 8, while 52% had greater than 8 HbA1c. The mean HbA1c in the hypomagnesemia group was 10.8±1.98, while in the normomagnesemia group, it was 8.9±2.2. There were 58.97% of foot ulcers in Group 1, while in Group 2, there were 31.14%.Around 38.46% and 14.75% had neuropathy in Groups 1 and 2, respectively. Nephropathy in Group 1 was 28.20%, while in Group 2, it was 11.47%. Around 69.23% of Group 1 had retinopathy and 37.70% had retinopathy in Group 2. Hypertension was 23.07% in Group 1 and 37.70% in Group 2; moreover, 7.69% and 8.19% had coronary diseases in Groups 1 and 2 accordingly. The current study concluded that hypomagnesemia was found to have an association with diabetic complications like neuropathy, nephropathy, foot ulcers, and poor glycemic control as evidenced by HbA1c.

Hypomagnesemia Is Associated with Excessive Daytime Sleepiness, but Not Insomnia, in Older Adults.

The aim of this study was to investigate associations between serum magnesium levels with insomnia and excessive daytime sleepiness (EDS) in older adults. A total of 938 older outpatients were included in the study. Hypomagnesemia was defined as serum magnesium concentration below <1.6 mg/dL. Patients were divided into two groups: hypomagnesemia and normomagnesia (1.6-2.6 mg/dL). The Epworth Sleepiness Scale was implemented and scores of ≥11 points were categorized as EDS. The Insomnia Severity Index was implemented and scores of ≥8 indicated insomnia. The mean age was 81.1 ± 7.6 years. While the presence of EDS, hypertension, diabetes mellitus, and coronary artery disease were more common in the hypomagnesemia group than the normomagnesia group, Parkinson's disease was less common (p < 0.05). Hemoglobin and HDL cholesterol were lower, whereas HbA1c, triglyceride, and number of drugs used were higher in the hypomagnesemia group compared to the normomagnesia group (p < 0.05). In both univariate analysis and multivariate analysis adjusted for gender, age and all confounders, there were significant associations between hypomagnesemia and EDS [odds ratio (OR):1.7; 95% confidence interval (CI): 1.6-2.6, and OR: 1.9; 95%CI: 1.2-3.3, respectively (p < 0.05)]. There was no significant relationship between hypomagnesemia and insomnia (p > 0.05). The present study identified an association between hypomagnesemia and EDS in older adults. Therefore, it may be prudent to consider hypomagnesemia when evaluating older adults with EDS and vice versa.

STUDY OF MICROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS AND THEIR RELATION TO SERUM MAGNESIUM LEVELS

BACKGROUND: Hypomagnesemia in diabetes indicates secondary magnesium deciency. It has been proposed that osmotic diuresis is reason for magnesium loss. Glycosuria which accompanies the diabetic state, impairs magnesium reabsorption from renal tubules. Present study aims to estimate serum magnesium levels in type 2 Diabetes mellitus patients and to correlate the serum magnesium levels with microvascular complications of diabetes-retinopathy, nephropathy, neuropathy. AIMS AND OBJECTIVES: To assess microvascular complications in T2DM related retinopathy , nephropathy , neuropathy and its correlation with serum magnesium levels. To assess the severity of microvascular complications in relation to serum magnesium levels. METHODS: 100 patients with diabetes mellitus who were admitted in general medical wards/ attended outpatient department were selected randomly for the study and were further divided into cases i.e diabetics with microvascular complications and controls i.e with out complications.Detailed history, thorough clinical examination, and relevant biochemical investigations were obtained from all patients. RESULTS: The study included 100 patients, with 63 percent having normal magnesium levels and the remaining 37 percent having hypomagnesemia. Among the 37% of hypomagnesemic people, 81 percent were cases and 18.9% were controls. In 50 percent of the cases, hypomagnesemia was discovered. In cases of hypomagesemia, 3.3 percent have one complication, 86 percent have two complications, and 10% have all three. In patients with normal magnesium levels, 63% have one complication, 33.3 percent have two complications, and 3.3 percent have all three. Patients with one complication are more in the normomagnesemia group, whereas patients with two complications are more in the hypomagnesemia group. Patients who have all three complications are more likely to be hypomagnesemic. CONCLUSIONS: There is signicant prevalence of low serum magnesium level in individuals with diabetes mellitus . Hypomagnesemia is signicantly associated with microvascular complications in type2 diabetes mellitus patients .

Hypomagnesemia is associated with increased mortality in the short-term but not the long-term in community-acquired pneumonia patients with type 2 diabetes

The present study explored the relationship between hypomagnesemia and outcome in community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM). The study was a retrospective cohort study, conducted on adult CAP patients with T2DM at The First Hospital of Qinhuangdao between January 2015 and December 2018. The primary outcome was all-cause deaths. In total, 480 CAP inpatients with T2DM were enrolled, and 71 patients (14.8%) had hypomagnesemia on admission. After one month and three months of follow-up, the hypomagnesemia group had a higher mortality rate than the normal magnesium group (p&lt;0.05). After six months of follow-up, the mortality rate remained higher in the hypomagnesemia group, however, this was not statistically significant (χ²=2.799, p=0.094). After 12 months and 24 months of follow-up, the mortality rates were similar between the hypomagnesemia and normal magnesium groups (p&lt;0.05). Based on multiple logistic regression analysis, hypomagnesemia was an independent risk factor for one-monthmortality(OR=3.858,95% CI: 1.637~9.088, p=0.002), three-month mortality (OR=3.083, 95% CI: 1.434~6.627, p=0.004) and six-month mortality (OR=2.551, 95% CI: 1.209~5.383, p=0.014). Hypomagnesemia is common in CAP inpatients with T2DM. Moreover, in these patients, hypomagnesemia at admission is associated with increased mortality in the short-term but not the long-term.

Hypermagnesaemia, but Not Hypomagnesaemia, Is a Predictor of Inpatient Mortality in Critically Ill Children with Sepsis.

Objective The effect of serum magnesium on the prognosis of children with sepsis in the pediatric intensive care unit (PICU) is unclear. This study was designed to assess the risk of inpatient mortality for children with sepsis in the PICU based on serum magnesium levels at admission. Methods We collected patients' clinical information from the Pediatric Intensive Care database and then performed locally weighted scatterplot smoothing (LOWESS) analysis, Kaplan–Meier analysis, and multivariate logistic regression to determine the relationship between admission serum magnesium and inpatient mortality in children with sepsis. Results A total of 974 critically ill children with sepsis were included, with 246 patients in the hypomagnesemia group, 666 in the normal group, and 62 in the hypermagnesemia group. The chi-square test suggested that the hypermagnesemia group had higher in-hospital mortality than the normal group (14.5% vs. 2.4%, P < 0.001). Kaplan–Meier curves revealed that the 30-day overall survival rate was lower in the hypermagnesaemia group than in the normal group (P < 0.001). The multivariate logistic regression model revealed that hypermagnesaemia was a risk factor related to inpatient mortality (odds ratio 4.22, 95% CI 1.55-11.50), while hypomagnesaemia was not a significant factor for inpatient mortality (odds ratio 0.78, 95% CI 0.26-2.32). Conclusion Hypermagnesaemia, but not hypomagnesaemia, is a predictor of inpatient mortality in critically ill children with sepsis.

Influence of hypomagnesemia on the prognosis of severe septic patients

To investigate the influence of hypomagnesemia on the prognosis of patients with severe sepsis. A retrospective study was conducted. The clinical data of 207 septic patients admitted to the department of critical care medicine of the First Affiliated Hospital of University of Science and Technology of China from January 1, 2016 to December 21, 2020 were analyzed, including gender, age and laboratory indicators within 24 hours after sepsis diagnosis [procalcitonin (PCT), C-reactive protein (CRP), blood lactic acid (Lac), pH value and blood magnesium, calcium, chlorine and phosphorus levels]. The acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and 28-day prognosis were collected. The patients were divided into survival group and non-survival group according to the prognosis, and the clinical data and laboratory indexes were compared between the two groups. Pearson correlation test was used to analyze the correlation between clinical indicators. Multivariate Logistic regression analysis was used to screen the risk factors affecting the prognosis. The receiver operator characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the potential prognostic indicators. Among the 207 septic patients, 102 survived and 105 died on the 28th day, and the 28-day mortality was 50.72%. There were no significant differences in gender, age, CRP, pH value, blood chlorine or blood phosphorus levels between the two groups. The blood magnesium and blood calcium levels in the non-survival group were significantly lower than those in the survival group [blood magnesium (mmol/L): 0.68±0.14 vs. 0.80±0.12, blood calcium (mmol/L): 1.93±0.21 vs. 2.01±0.20, both P > 0.01], and PCT, Lac, APACHE II score and SOFA score were significantly higher than those in the survival group [PCT (mg/L): 8.32 (1.64, 55.01) vs. 3.55 (0.97, 12.31), Lac (mmol/L): 2.90 (1.70, 4.30) vs. 2.10 (1.03, 3.89), APACHE II score: 21.24±6.40 vs. 17.42±7.02, SOFA score: 9.14±3.55 vs. 6.91±3.31, all P > 0.01]. Among the 207 patients, 96 patients had normal blood magnesium level (0.75-1.25 mmol/L) and 111 patients had hypomagnesemia (> 0.75 mmol/L). The 28-day mortality of septic patients in the hypomagnesemia group was significantly higher than that in the normal magnesium group [61.26% (68/111) vs. 38.54% (37/96), P < 0.01]. Pearson correlation analysis showed that the blood magnesium level of sepsis patients was negatively correlated with PCT (r = -0.173, P < 0.05), and it was positively correlated with APACHE II score (r = 0.159, P < 0.05), but it had no correlation with CRP or SOFA score (r values were -0.029 and 0.091, both P > 0.05). Logistic regression analysis showed that serum magnesium, APACHE II score and SOFA score were independent risk factors for 28-day death in patients with sepsis [serum magnesium: odds ratio (OR) < 0.001, 95% confidence interval (95%CI) was 0.000-0.002, P < 0.001; APACHE II score: OR = 1.092, 95%CI was 1.022-1.168, P = 0.010; SOFA score: OR = 1.168, 95%CI was 1.026-1.330, P = 0.019]. ROC curve analysis showed that blood magnesium and APACHE II score had a certain predictive value for 28-day mortality in patients with severe sepsis [AUC (95%CI) was 0.723 (0.655-0.791) and 0.680 (0.607-0.754), respectively]. When the blood magnesium threshold was 0.64 mmol/L, the sensitivity was 41.0% and the specificity was 93.1%. When APACHE II score threshold was 16.50, the sensitivity was 78.1% and the specificity was 55.9% indicating that the specificity of serum magnesium was higher than that of APACHE II score. Severe septic patients complicated with hypomagnesemia have a poor prognosis. Serum magnesium level can be used as a prognostic indicator for severe septic patients.

The association between abnormal serum magnesium levels and prognosis of elderly patients with community-acquired pneumonia

To investigate the association between abnormal serum magnesium levels and the prognosis of elderly patients with community-acquired pneumonia (CAP). Methods: A retrospective study was conducted on 1381 elderly patients with CAP in the First Hospital of Qinhuangdao between January 2015 and December 2018. Serum magnesium concentrations in the range of 0.75-1.25 mmol/L were defined as normal. Patients were assigned into normal, hypomagnesemia, and hypermagnesemia groups. The primary outcome was in-hospital mortality, indicating whether a patient died at the time of discharge from the hospital. The percentages of respiratory failure and mechanical ventilation were 18.6% and 10.6 % in the normal group, 29% and 16.5 % in the hypomagnesemia, and 42.9% and 35.7% in the hypermagnesemia groups. The occurrence of shock was 8.5% and 4.5% in the hypomagnesemia group and the normal group. The percentages of the length of stay at ICU were 14.9%, 18.8%, and 57.1% in the hypomagnesemia, normal, and hypermagnesemia groups. The in-hospital mortality rate was 5.3%, 9.1%, and 35.7% in the normal, hypomagnesemia, and hypermagnesemia groups, respectively. The results of univariate analysis showed that the in-hospital mortality in the hypomagnesemia group was 1.790 (95% confidence interval (CI): 1.009∼3.176, P=0.046) times higher than that in the normal group; in the hypermagnesemia group, it was 9.947 (95% CI: 3.238-30.556, P<0.001) times higher than that in the normal group. The results of multivariate logistic regression analysis showed that after adjusting for gender, age, diabetes, heart failure, cerebrovascular disease, cancer, estimated glomerular filtration rate (eGFR), glucose, and CURB-65 score, in the hypomagnesemia group, the in-hospital mortality was 1.746 (95% confidence interval (CI): 0.956∼3.186, P=0.070) times higher than that in the normal group, and 5.689 (95% CI: 1.583- 20.446, P=0.008) times higher in the hypermagnesemia group than that in the normal group. Abnormal serum magnesium levels are strongly associated with in-hospital mortality in elderly patients with CAP. The measurement of serum magnesium levels in elderly patients with CAP at admission may assist clinicians to determine the prognosis of such patients.

Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study

BackgroundThe occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT.MethodsThis was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group.ResultsAmong the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged.ConclusionBiochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

Influences of Hypomagnesemia on Optic Nerve and Retinal Vascular Structure Determined Using Optical Coherence Tomography (OCT) Angiography.

ABSTRACT Purpose: To evaluate the effects of low blood magnesium levels on the optic nerve, retina, and retinal vascular structure. Methods: This observational and cross-sectional study was conducted between June 2019 and May 2020 with participants aged 20–39 years, who had a visual acuity of ≥20/20, the axial length of 22–24.5 mm, refractive defect spherical equivalent of ≤±3D, and intraocular pressure of ≤21 mm Hg. All participants had a complaint of twitching in their eyes. The participants with normal serum magnesium levels constituted the control group, and patients with hypomagnesemia constituted the patient group. Updated AngioScan software (Navis ver. 1.8.0.) of Nidek’s RS-3000 Advance system was used to analyze the spectral domain-optical coherence tomography (SD-OCT) and optical coherence tomography-angiography (OCT-A) images. Results: A total of 100 right eyes of 100 individuals was included in the study. The mean retinal nerve fiber layer (RNFL) thickness was 108.52 ± 12.46 μm in the control group, and 97.3 ± 9.7 μm in the hypomagnesemia group (P < .001). In the control group, the global superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VDs) were 41.92 ± 2.29, and 37.54 ± 3.83, respectively. In the patient group, the global SCP and DCP VDs were 37.66 ± 3.14, and 32.95 ± 5.57, respectively. The SCP and DCP VD percentages were significantly lower in the patient group. The mean foveal avascular zone (FAZ) area, perimeter and circularity index (CI) were 0.32 ± 0.13 mm2, 2.89 ± 0.59 mm, and 0.52 ± 0.09, respectively, for the control group and 0.38 ± 0.11 mm2, 2.99 ± 0.64 mm, and 0.38 ± 0.1, respectively, for the patient group. The FAZ area and perimeter were significantly higher (P = .013 and P = .001) and FAZ CI was significantly lower (P < .001) in the patients with hypomagnesemia. Conclusion: Our study revealed that OCT and OCT-A measurements may be used in the determination of the optic nerve and retinal vascular structure changes in hypomagnesemia.

Association between serum magnesium and anemia in patients with chronic kidney disease.

An inverse association was shown between serum magnesium levels and anemia in the general population. However, limited information is available about the association between serum magnesium level and anemia in the patient population with chronic kidney disease. We aimed to investigate the relationship between hypomagnesemia and anemia in pre-dialysis patients with chronic kidney disease stage 3-5. This cross-sectional retrospective study included 213 chronic kidney disease patients with an estimated glomerular filtration rate of 60mL/min and below. Laboratory and demographic data of outpatients were collected in January 2018-January 2019. Patients with a magnesium level below 1.9mg/dL were accepted as the hypomagnesemia group. Serum magnesium level of 62 (29.1%) of these patients were below 1.9mg/dL. Compared with normomagnesemic patients, hypomagnesemic patients had lower mean hemoglobin values (11.3g/dL vs. 12.7g/dL, P < 0.001), proton-pump inhibitor usage rates were significantly higher (33.9% vs. 17.2%, P = 0.008) and the median urine protein/creatinine ratio was found to be significantly higher (1017.5mg/gCr vs. 536mg/gCr, P = 0.045). In the multivariate analysis, the use of hemoglobin (OR 0.634; 95% CI 0.505-0.795; P < 0.001) and proton-pump inhibitor (OR 2.670; 95% CI 1.113-6.318; P = 0.025) were independent predictors of hypomagnesemia. Hypomagnesemia is a common electrolyte disorder in pre-dialysis CKD patients. In this patient group, anemia is independently associated with hypomagnesemia.

Risk factors and clinical outcome of hypomagnesemic patients in pediatric intensive care

Background: Hypomagnesemia is a common finding in current medical practice, especially in critically ill patients. Magnesium ion plays a vital role in various metabolic processes in body and its deficiency leading to serious clinical consequences. Since hypomagnesemia is most often asymptomatic, it goes unsuspected and therefore undiagnosed. Hence, early detection of hypomagnesemia has prognostic and therapeutic implications. It is imperative to understand the various risk factors and their clinical outcome that is associated with hypomagnesemia.Methods: This is an observational study done in a tertiary centre in Bangalore, India where-in 100 children who met the inclusion criteria, admitted to the PICU were recruited and prospectively studied. Serum Magnesium along with various clinical and biochemical parameters were correlated to enumerate the various risk factors associated with hypomagnesemia.Results: In this study authors found the incidence of hypomagnesemia to be around 53%. Authors found higher incidence in age group of 1-5 yrs (40%) and least were in the age groups of &lt;1 year and more than 10 years (19%) and there was no gender preponderance. Authors also evaluated the various risk factors associated with hypomagnesemia. There was significant association of hypocalcemia (60%) and hypokalemia (45.2%) with hypomagnesemia. Infections (33.9%) and neurological disorders (26.41%) seemed to collectively comprise around 60% of the hypomagnesemic group. All patients admitted secondary to sepsis and Traumatic Brain Injury (TBI) had hypomagnesemia proving to be a significant risk factor. Authors also found increased mortality among hypomagnesemic group. However, found no association between low serum magnesium and PICU stay.Conclusions: There is high prevalence of hypomagnesemia in critically ill patients and is associated with a higher mortality. It is also commonly associated with infections, CNS disorders, respiratory diseases and metabolic derangements like hypokalaemia and hypocalcaemia. There is no association of Hypomagnesemia with duration of PICU stay.

Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

Background: Admission hypomagnesemia has been linked with an increased risk of septic shock. The purpose of this study was to evaluate admission serum magnesium levels in patients with septic shock and to determine its correlation with the outcomes.Methods: It was a prospective observational study. Total 50 patients fitting the Sepsis-3 definition between time period of June 2017 to November 2018 were included in the study. Patients with suspected infection were identified at the bedside with qSOFA. Admission serum magnesium levels was measured for all patients included. APACHE II scores were calculated at the end of 24 hours after admission. Routine standard of care treatment was provided to all patients. The patients were monitored for organ dysfunctions based on daily SOFA scores, ventilator free days, vasopressors free days, dialysis free days, length of intensive care unit stay, length of hospital stay. The data was analysed using Statistical Package for Social Sciences for MS Windows.Results: In this study hypomagnesemia was prevalent in 18%, normomagnesemia in 62% and hypermagnesemia in 20% of total included patients. The mean vasopressor free days in Hypomagnesemia group (7.11±12.79 days) were higher than those in normomagnesemic patients (5.06±5.51 days) and hypermagnesemia patients (1.70±3.09 days). Out of total 50 patients 18 died and 32 recovered. 11 patients out of 32 who recovered had abnormal admission serum magnesium levels whereas 8 pts out of 18 who died had abnormal admission serum magnesium levels. SOFA score in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients was statistically significant.Conclusions: Author did not find any statistically significant correlation between admission magnesium levels in septic shock patients and outcomes although SOFA score was higher in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients. Serum magnesium may not truly reflect body’s magnesium status. RBC magnesium may need to be studied to see whether it is a more reliable biomarker.

The Relationship between Magnesium Level with Glucose Regulation and Amount of Proteinuria in Type 2 Diabetes

Diabetes Mellitus is a globally common, chronic metabolic disease. In progression of disease itself, peripheral insulin resistance and insulin secretion disorders can be observed. In addition there can be electrolyte disorders such as magnesium, calcium and iron deficiency. Magnesium levels may have significant role in the clinical course of the disease. In this study, it is aimed to observe relationship among magnesium levels glucose regulation and proteinuria. In this cross sectional study, 200 diabetic patients were examined for magnesium levels. Blood parameters and proteinuria levels were determined and the patients were divided into two groups as hypomagnesemic and normomagnesemic. Glucose levels, HbA1c and proteinuria levels were compared between groups. Of the cases (n=200), 59 (29.5 %) were male and 141 (70.5 %) were female. The frequency of hypomagnesemia was 38.5 %. The incidence of hypomagnesemia in women (46.1 %) was significantly higher than in men (20.3 %) (p=0.001). In hypomagnesemia group, glucose level (179.7 ± 60.2 mg/dL) was higher than normomagnesemia group (160.7 ± 52 mg/dL) (p=0.013). However, no statistically significant difference was observed between the groups in terms of HbA1c level. Proteinuria levels were higher in hypomagnesemia group (0.18 ±0.12 mg/mg) than normomagnesemia group (0.14±0.05 mg/mg) (p=0.013). Magnesium deficiency is a common condition in diabetic patiens and may have negative effects on glucose regulation and proteinuria. Randomized controlled trials are needed to clarify the role of magnesium in diabetic complications. Keywords: Diabetes Mellitus, magnesium, proteinuria DOI: 10.7176/JSTR/5-10-02

Effect of hypomagnesemia on elderly patients with intracerebral hemorrhage

Objective To investigate the effects of hypomagnesemia on the initial amount of hematoma and patient's condition at hospitalization in elderly patients with intracerebral hemorrhage(ICH). The 90 consecutive hospitalized patients with primary ICH were chosen for prospective cohort study in the Second Hospital of Anhui Medical University from February 2017 to May 2018. Methods Demographic and baseline data of patients were collected, and CT scan, serum magnesium concentration and other laboratory examinations after hospital admission were tested.Ninety patients were divided into two groups: hypomagnesemia group(serum magnesium <0.75 mmol/L, n=38)and normo-magnesemia group(0.75-1.25 mmol/L, n=52). The impact of serum magnesium level on the patient's initial volume of hematoma and critical condition at admission were analyzed. Results The median value of random blood glucose(7.29 mmol/L vs.6.44 mmol/L)and fibrinogen degradation products(3.43 mg/L vs.1.98 mg/L)were higher in the patients with hypomagnesemia than in the normal magnesium group.The median volume of initial volume of hematoma at admission was larger in patients with hypomagnesemia than in the normal magnesium group(20 cm3vs.10 cm3). The median value of Glasgow coma scale at admission was lower in patients with hypomagnesemia than in the normal magnesium group(12.5 scores vs.14.0 scores). And their difference was statistically significant(U=-2.663, -2.951, -5.000 and -2.821 respectively, P=0.008, 0.003, 0.000 and 0.005). The correlation analysis showed that the initial volume of hematoma in patients with intracerebral hemorrhage was negatively correlated with the serum magnesium concentration at admission(r=-0.528, P=0.001). Conclusions Patients with hypomagnesemia has a larger hematoma volume and more serious disease condition.There is a significantly negative correlation between serum magnesium and hematoma volume of ICH.The serum magnesium level may become a predictor of ICH in the future. Key words: Cerebral hemorrhage; Magnesium deficiency; Hematoma

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Background: Magnesium deficiency is common in critical illness and is said to be associated with increased need for mechanical ventilation, mortality and prolonged ICU stay. The knowledge of hypomagnesemia is essential as available data is scarce and it could have prognostic and therapeutic implications. This study was undertaken to estimate the prevalence of hypomagnesemia at the time of admission in PICU and its correlation with length of PICU stay, duration on mechanical ventilator and outcome at the end of hospital stay-death or discharge.Methods: This is a prospective observational study including 343 children aged 1month to 12years admitted to PICU. Detailed history taking and clinical examination was done for all enrolled children. At admission, blood was collected for estimation of serum magnesium. Patients were categorized into three groups i.e., hypomagnesemia, normomagnesemia and hypermagnesemia and data was analysed.Results: Out of 343 children, 28% had hypomagnesemia, 7.3% had hypermagnesemia and 64.7% had normomagnesemia. Hypomagnesemia was more common in neurological disorders. No association was found between magnesium and length of mechanical ventilation. PICU stay was significantly longer in hypomagnesemia group (p=0.031). 37.5% patients with hypomagnesemia also had hypocalcemia and 35.4% had hypokalemia. Mortality rate was higher in those with hypomagnesemia (30.2%) compared to those with normomagnesemia (22.1%).Conclusions: Patients with hypomagnesemia had increased duration of PICU stay, other associated electrolyte abnormalities and higher mortality. Hence monitoring of magnesium levels in critically ill patients is indicated.

Association of serum magnesium with type 2 diabetes mellitus and diabetic retinopathy.

Introduction and Objective:The rising burden of type 2 diabetes mellitus (T2DM) globally has led to huge morbidity and socioeconomic impact in developing countries. In India, too, it has become a silent epidemic and it is estimated that there are over 60 million diabetics. Although in recent years, a lot of research papers have come up on the management of diabetes, latest treatment modalities may not be affordable to all. So, it becomes imperative to prioritize research on prevention and primary care. Magnesium is an intracellular cation and coenzyme for various reactions of the glycolytic pathway. Hypomagnesemia has been shown to precipitate hyperglycemia and has, therefore, been implicated in insulin resistance and its microvascular complications. Poor glycemic control has been associated with retinopathy. Hence, we evaluated association of serum magnesium with T2DM and diabetic retinopathy.Materials and Methods:In a cross-sectional study in North India, 250 consenting adult patients from outpatient department of family medicine of our hospital were recruited. Critically ill patients and those on magnesium supplements were excluded. Clinicolaboratory profile was evaluated. Patients were divided based on serum magnesium level ≤ 1.7 mg/dL (group 1) and > 1.7 mg/dL (group 2). Glycemic control and proportion of diabetic retinopathy were compared between these two groups by using univariate regression analysis.Results:Out of 250 patients, 110 patients (44%) were found to have hypomagnesemia. Glycemia by fasting blood sugar (P = 0.02), post-Prandial blood sugar (P = 0.04), and HbA1C(P = 0.01) was poorly controlled in hypomagnesemia group. In group 1, 62.7% had non proliferative diabetic retinopathy and 21.8% had proliferative diabetic retinopathy, whereas in group 2, 14.3% had nonproliferative diabetic retinopathy and 8.6% had proliferative diabetic retinopathy (P < 0.001).Conclusions:Magnesium deficiency is associated with increased risk of diabetic retinopathy and poor glycemic control. Dietary supplementation may be advised to prevent such complications and improve glycemic control.