Hypomagnesemia In Patients Research Articles

Occurrence and Effect of Hypomagnesemia in Patients Suffering from Guillain-Barre Syndrome in Intensive Care Unit

Background: Predicting patient outcome is an important component of patient care in the critical care units. It has a vital importance to the intensivists. Because it allows the planning of early aggressive therapeutic interventions, optimum resource allocation and appropriate counseling of the family as well as the patient. So the intensivists have developed a number of prognostication tools for the patient admitted to ICU for above purpose. The two widely adopted systems to predict mortality are the Acute Physiology Assessment Chronic Health Evaluation (APACHE2) & Simplified Acute Physiology Score(SAP).Though useful, these tools are complex & require input of a large number of variables derived from patients history, physical examination & initial laboratory data. In several studies, it has been shown that serum magnesium level has great effect on mortality & morbidity in critically ill patient. But there is no study to observe the effect of hypomagnesium on the outcome of GBS in ICU. Methods and materials: A prospective observational study in the intensive care unit of DMCH from January 2014 to December 2015. Thirty patients admitted to the ICU with suspected GBS requiring intensive care for more than at least 2 days with age more than 18 years were included. A blood sample was collected for estimation of serum total magnesium level on the day of admission to ICU. Finally all collected data were tabulated and analysed using standard statistical methods by SPSS version 17 for Windows. The Chisquare test was applied to correlate hypomagnesemia & normomagnesemia with the outcome. Result: Total numbers of patients were thirty. 40% of patient had been suffering from hypomagnesemia. 40% patient needed mechanical ventilation.The mean length of mechanical ventilation days were higher in hypomagnesemic patients than normomagnesemic with were 17.66±8.40 vs 12.05±3.68 days. The mean length of ICU stay were 20.50(±9.48) days in hypomagnesemia and 14.22(±3.33) days in normomagnesemics. 33.33% patient had hyponatremia,58.33% patient had hypokalemia,50% patient had hypocalcemia. 50% patients with hypomagnesemia had sepsis. :Mortality rate in hypomagnesemic patients were 80% that were 20% in normomagnesemia. Conclusion: Hypomagnesemia has played a pivotal role in prediction of mortality and morbidity in GBS. So hypomagnesemia can be used as a prediction tool for patient suffering from GBS in ICU. JBSA 2017; 30(1): 21-26

The Incidence of Cisplatin-induced Hypomagnesemia in Cervical Cancer Patients Receiving Cisplatin Alone.

Hypomagnesemia is one side effect in patients receiving cisplatin. However, there are few reports of cisplatin-induced hypomagnesemia in Japan. We retrospectively investigated the incidence of hypomagnesemia and nephrotoxicity in patients undergoing radiation therapy who were treated with cisplatin alone (dosage: 40 mg/m2, administration interval: 1 week) for cervical cancer. Thirty-two patients undergoing radiation therapy who received cisplatin alone for cervical cancer between January 2012 and May 2016 at Aichi Medical University Hospital were included. We measured patients' serum magnesium and creatinine levels on the day before cisplatin was administered. We utilized the RIFLE criteria (categorized into "risk", "injury", "failure", "loss", and "end-stage kidney disease") to define levels of cisplatin-induced nephrotoxicity, and classified cisplatin-induced nephrotoxicity into "risk" or "injury". Eighteen patients (56.3%) had cisplatin-induced hypomagnesemia, the majority of which occurred after the 4th treatment cycle. The number of patients with moderate renal dysfunction classified as "risk" in the hypomagnesemia group was not significantly higher than in the non-hypomagnesemia group (hypomagnesemia group=27.8%, non-hypomagnesemia group=7.1%; p=0.20). This survey sheds light on the incidence rates of cisplatin-induced hypomagnesemia in patients receiving cisplatin alone. We recommend monitoring the serum magnesium levels during cisplatin administration to prevent hypomagnesemia.

Incidence and Risk Factors of Hypomagnesemia in Head and Neck Cancer Patients Treated with Cetuximab.

Hypomagnesemia is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the incidence and risk factors of hypomagnesemia in head and neck cancer patients treated with Cmab. We retrospectively reviewed 131 head and neck cancer patients who received Cmab-containing therapy. Main eligibility criteria were ≥3 Cmab administrations, no prior EGFR-directed therapy, and no prophylactic Mg supplementation. Median baseline serum Mg level and number of Cmab administrations were 2.2 mg/dl and 8, respectively. Overall incidence of hypomagnesemia was 50.4% (grade 1, 46.6%; grade 2, 3.1%; grade 3, 0%; and grade 4, 0.8%) and differed between patients treated with palliative chemotherapy and bioradiation (Cmab and radiation) (63 versus 24%; P < 0.01). Independent risk factors were low baseline serum Mg [odds ratio (OR) 161.988, 95% confidence interval (CI) 9.436-2780.895], ≥7 Cmab administrations (OR 3.56, 95% CI 1.16-13.98), and concurrent administration of platinum (cisplatin; OR 23.695, 95% CI 5.219-107.574, carboplatin; OR 5.487, 95% CI 1.831-16.439). Respective incidence of hypomagnesemia in patients in high- (concurrent platinum and ≥7 Cmab administrations) and low-risk (no concurrent platinum and <7 Cmab administrations) groups was 66.0 and 6.6% (P < 0.001, OR 28.0). Cmab is associated with a significant risk of hypomagnesemia in patients with head and neck cancer with longer term administration and concurrent platinum therapy. High-risk patients should be treated with particular care.

Hypomagnesemia Is Prevalent in Patients Undergoing Gynecologic Surgery by a Gynecologic Oncologist.

The aim of this study was to assess the incidence of and risk factors for hypomagnesemia in patients undergoing gynecologic surgery by a gynecologic oncologist. A retrospective chart review was performed on all patients undergoing surgery for gynecologic pathology from July 2011 to July 2015 by a single surgeon. Demographic data, surgical indication, surgery performed, preoperative laboratory values, postoperative laboratory values, and medical history were examined. Hypomagnesemia was defined as less than 1.8 mg/dL. Hypermagnesemia was defined as greater than 2.5 mg/dL. Six hundred sixty-nine patients were identified for analysis. One hundred ninety-seven patients had hypomagnesemia (29.4%). Four hundred sixty-six patients had normal magnesium levels (69.5%), and 6 patients had hypermagnesemia (1%). Among patients with benign disease, 24.9% had preoperative hypomagnesemia compared with 32.7% of patients with a gynecologic malignancy. African American race (P = 0.041), diabetes mellitus (P < 0.001), and malignancy (P = 0.029) were all associated with preoperative hypomagnesemia. Diabetes and major surgery were associated with postoperative hypomagnesemia (P = 0.012 and P = 0.048, respectively). Hypomagnesemia was associated with increased preoperative and postoperative pain (P = 0.049 and P < 0.001, respectively) as well as postoperative hypokalemia (P = 0.001). Age, body mass index, hypertension, cancer type, hematocrit, surgical indication, and length of hospital stay were not associated with hypomagnesemia. Perioperative hypomagnesemia is prevalent in patients undergoing gynecologic surgery by a gynecologic oncology, especially in patients who have a gynecologic malignancy. We recommend routine preoperative and postoperative evaluation of serum magnesium in all patients undergoing gynecologic surgery by a gynecologic oncologist.

Abnormalities of magnesium homeostasis in patients with chemotherapy-induced alimentary tract mucositis

Purpose: Hypomagnesemia contributes to morbidity in a significant proportion of hospitalized and severely ill patients, but it could also have beneficial anticancer effects. Alimentary tract mucositis is a frequent complication of cytotoxic chemotherapy. The aim of this study was to determine frequency and severity of hypomagnesemia in patients with different grades of chemotherapy-induced alimentary tract mucositis and to assess its clinical manifestations. Methods: Multicentric observational study included 226 adult patients with alimentary mucositis treated at 3 different institutions. Patients were evaluated for severity of mucositis and the presence of hypomagnesemia, symptoms associated with hypomagnesemia, hypocalcemia, ECG changes and granulocytopenia. Subgroup analysis related to mucositis severity and presence of hypomagnesemia was performed. Results: Patients with grade 3 or 4 alimentary mucositis expectedly had more frequent and more severe granulocytopenia than patients with milder mucositis (49.6% vs. 35.4%, P = 0.043), but there were no differences in rate of hypomagnesemia (24.8% vs. 26.5%). When compared to patients with normal magnesium levels, patients with hypomagnesemia had higher rates of hypocalcemia (50.0% vs. 32.7%, P = 0.026), QTc prolongation (15.5% vs. 3.0%, P = 0.002) and granulocytopenia (77.6% vs. 39.9%, P < 0.001), while there was no difference in symptoms or other ECG features among these subgroups. Conclusions: Hypomagnesaemia is not associated with the severity of chemotherapy-induced mucositis. However, hypomagnesaemia was associated with higher rates of granulocytopenia and hypocalcemia. Our study failed to identify the link between hypomagnesaemia and chemotherapy-induced mucositis.

Analysis of Factors Influencing the Development of Hypomagnesemia in Patients Receiving Cetuximab Therapy for Head and Neck Cancer

Cetuximab was approved in Japan as the only clinically available molecular targeted drug for the treatment of head and neck cancer. Hypomagnesemia associated with cetuximab is considered one of the most serious adverse events. However, the factors influencing the development of hypomagnesemia are not clear, although the drug was previously approved for the treatment of patients with colorectal cancer. Thus, we studied the factors involved in the development of hypomagnesemia in patients receiving cetuximab therapy for head and neck cancer. Patients' background data and laboratory values before starting cetuximab therapy did not affect the development of hypomagnesemia. Among patients who had never been treated with cisplatin (NT group), 36.4% developed hypomagnesemia. In contrast, all patients who had previously been treated with cisplatin (T group) developed hypomagnesemia (p=0.034). Magnesium is reabsorbed by transient receptor potential subfamily melastatin 6 (TRPM6) in the distal convoluted tubule. The expression level of TRPM6 is controlled by the epidermal growth factor (EGF) pathway. Cetuximab is an EGF receptor inhibitor and reduces the expression of TRPM6. Additionally, recent studies have shown that the expression of TRPM6 is reduced by cisplatin. Therefore, we considered that the serum magnesium level was cumulatively reduced by cetuximab and cisplatin. In conclusion, the T group was more likely to develop hypomagnesemia than the NT group, and therefore the serum magnesium level in the T group requires careful monitoring so that magnesium supplementation can be provided to patients when the level decreases.

The Role of Magnesium in Post-thyroidectomy Hypocalcemia.

The purpose of this study was to determine the prevalence of hypomagnesemia in patients undergoing thyroidectomy and evaluate the relationship of hypomagnesemia with transient and severe hypocalcemia. This was a prospective observational study of 50 patients undergoing thyroidectomy. Blood samples were collected pre- and postoperatively for calcium, albumin, magnesium, phosphorous and parathormone (PTH). Signs, symptoms of hypocalcemia and volume of intravenous fluids used perioperatively were documented. The statistical analysis was performed using STATA I/C 10.1. Preoperatively, twelve patients (24 %) had hypomagnesemia and one (2 %) hypocalcemia. On the first postoperative day, hypomagnesemia was seen in 70 % and hypocalcemia in 30 %. A similar trend was observed in the fall and rise of postoperative calcium and magnesium values (p = 0.41). Severe hypocalcemia was present in three patients (6 %). All three patients had a very low postoperative PTH (<2 pg/ml). Among them, two patients (66 %) had hypomagnesemia and their hypocalcemia responded to intravenous magnesium correction. Significant risk factors for postoperative hypocalcemia include a higher volume of fluid used perioperatively and low postoperative PTH (<8 pg/ml) (p = 0.01 and 0.03, respectively). Preoperative hypomagnesemia (24 %) was prevalent in this cohort of patients. Postoperative hypomagnesemia is a common event (70 %) following total thyroidectomy, and magnesium levels tend to mimic the calcium levels postoperatively. The cause of hypocalcemia post-thyroidectomy in this study is mainly a factor of parathyroid function and fluid status. Severe hypocalcemia is a rare event, and hypomagnesemia is associated in the majority of these patients. The role of magnesium correction to alleviate severe hypocalcemia needs to be further studied.

Assessment of frequency and severity of hypomagnesemia in patients with metastatic colorectal cancer treated with cetuximab, with a review of the literature.

Currently, there are a few systemic treatment options for patients with metastatic colorectal cancer (mCRC). Targeted therapy used in this setting includes the use of monoclonal antibodies, such as cetuximab or panitumumab, directed against epidermal growth factor receptor. The aim of the present study was to estimate the frequency and severity of hypomagnesemia among patients with mCRC treated with cetuximab. The data from the Department of Clinical Oncology, University Hospital of Krakow (Krakow, Poland), concerning 52 patients treated between 2009 and 2013 were collected. Of these, 27 patients fulfilled the inclusion criteria to enter this retrospective study. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 were used to grade the level of hypomagnesemia. In total, 29.6% of all patients experienced hypomagnesemia during treatment, and the majority of cases were grade 1 (22.2%). There was no statistically significant correlation between magnesium (Mg) level and patient age, duration of treatment, localization of primary tumor or metastases, and the number of metastases. However, there was an upward trend in a logistic regression model showing that the risk of developing hypomagnesemia increases with age. Hypomagnesemia is a frequent problem among mCRC patients receiving cetuximab. It is essential to introduce guidelines regarding the monitoring of the Mg level and its supplementation in this group of patients.

Prevalence of hypomagnesemia in patients with HER2–positive breast cancer receiving pertuzumab treatment.

e11608 Background: Human Epidermal growth factor Receptor-2 (HER2) is a member of the epidermal growth factor (EGFR) family of transmembrane receptors and is overexpressed in ~20% of breast cancers (BC). Pertuzumab (P) blocks HER2 dimerization with HER3, EGFR, and HER1. When administered with trastuzumab (T) and chemotherapy, P prolongs overall survival in patients (pt) with HER2+ metastatic BC (MBC). P is FDA-approved for pt with HER2+ MBC and high risk, early stage BC. We observed unexplained CTCAE grade (G) 3 hypomagnesemia (HypoMg) and urine Mg wasting in a pt receiving P. This phenomenon was noted with other EGFR inhibitors (e.g. cetuximab, panitumumab) following their approval and widespread use. The kidney distal convoluted tubule is the site of active transcellular Mg reabsorption under direct EGF control. We therefore hypothesized that P-mediated blockade may inhibit Mg reabsorption and sought to further define the phenomenon. Methods: With IRB approval we retrospectively reviewed the electronic records of pt with HER2+ BC receiving P at MSKCC from 10/2013-01/2015 who had serum Mg data available. Hypothesis generating descriptive statistics, including prevalence, mean and time to event, were performed. Results: 353 pt received P, 233 had serum Mg data available (143 MBC and 90 early stage BC). Of the pt with MBC who received P, HypoMg ( ≥ G1) was identified in 20/143 (14%); 11 had additional risk factors for HypoMg (prior platinum n = 4, diarrhea n = 4, antibiotic n = 3). In the (neo)adjuvant setting, HypoMg ( ≥ G1) was observed in 8/90 (9%) pt receiving P. Time to onset of HypoMg in pt receiving P: MBC = 216 (3-1022) days; (neo) adjuvant = 33 (5-94) days. Conclusions: HypoMg may be a class effect of EGFR family inhibitors and the interaction of P with EGFR/HER1 may underpin the potential to increase the risk of HypoMg. T is not known to be associated with HypoMg but the differing mechanism of action of P or the impact of dual HER2 blockade may have implications for magnesium handling. We plan to assess HypoMg rates in pt with HER2+ BC who have not been treated with P to provide additional insight into whether this is a distinct characteristic of P therapy. If confirmed, these data could support Mg monitoring in pt receiving P.

Hypomagnesaemia linked to depression: a systematic review and meta-analysis.

The reported risk of depression in patients with hypomagnesaemia is controversial. The objective of this meta-analysis was to assess the association between depression and hypomagnesaemia. A literature search was performed using MEDLINE, EMBASE, Cochrane Database and clinicaltrials.gov from inception through October 2014. Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of depression in patients with hypomagnesaemia were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Six observational studies (three cohort studies, two cross-sectional studies and a case-control study) with a total of 19,137 patients were identified and included in the data analysis. The pooled RR of depression in patients with hypomagnesaemia was 1.34 (95% CI, 1.01-1.79, I(2) = 33%). The association between depression and hypomagnesaemia was marginally insignificant after the sensitivity analysis including only cohort and case-control studies, with a pooled RR of 1.38 (95% CI, 0.92-2.07, I(2) = 24%). Our study demonstrates a potential association between hypomagnesaemia and depression. Further studies assessing the benefits of treatment of hypomagnesaemia in patients with depression are needed.

Hypomagnesemia Induced by Long-Term Treatment with Proton-Pump Inhibitors.

In 2006, hypomagnesemia was first described as a complication of proton-pump inhibitors. To address this issue, we systematically reviewed the literature. Hypomagnesemia, mostly associated with hypocalcemic hypoparathyroidism and hypokalemia, was reported in 64 individuals on long-term proton-pump inhibitors. Hypomagnesemia recurred following replacement of one proton-pump inhibitor with another but not with a histamine type-2 receptor antagonist. The association between proton-pump inhibitors and magnesium metabolism was addressed in 14 case-control, cross-sectional studies. An association was found in 11 of them: 6 reports found that the use of proton-pump inhibitors is associated per se with a tendency towards hypomagnesemia, 2 found that this tendency is more pronounced in patients concurrently treated with diuretics, carboplatin, or cisplatin, and 2 found a relevant tendency to hypomagnesemia in patients with poor renal function. Finally, findings likely reflecting decreased intestinal magnesium uptake were observed on treatment with proton-pump inhibitors. Three studies did not disclose any relationship between magnesium metabolism and treatment with histamine type-2 receptor antagonists. In conclusion, proton-pump inhibitors may cause hypomagnesemia. In these cases, switching to a histamine type-2 receptor antagonist is advised.

Association of Proton Pump Inhibitor with Hypomagnesaemia: A Cross-Sectional Study at a Tertiary Care Hospital of Anand District

Proton pump inhibitors (PPIs) are one of the most commonly used class of drugs for gastroesophageal reflux disease and number of other common persistent conditions. Hence, risk of potential long-term side effects associated with the use of PPIs is increasing. On March 2, 2011, the US FDA informed the public of the risk of hypomagnesaemia associated with prolonged usage of PPIs. Hence, the present study was undertaken to estimate the risk of development of hypomagnesaemia in patients who have been treatment with PPIs for at least one month and to check whether PPI induced hypomagnesaemia is a long term side effect with all PPIs. General demographic data, type of PPI used along with its duration of use and dose, morbid conditions, concomitant illness and several other confounders available from the basic metabolic panel of 60 patients (30 long term PPI users and 30 non PPI users), was collected and documented using a structured questionnaire. Serum magnesium levels of all 60 patients were estimated and data collected was analysed using T-test and ANOVA. Users on PPIs and non users had a mean serum magnesium level of 1.848 ± 0.023 mg/dL and 2.167 ± 0.34 mg/dL respectively, with the difference being statistically significant (p=0.00) and was independent of age, gender and concomitant drugs prescribed. However female PPI users had slightly lower serum Mg levels. Of the 30 recruited PPI users, 4 were asymptomatic hypomagnesaemic (serum Mg levels<1.7 mg/dL). Mean serum Mg levels in esomeprazole users were slightly higher than those on omeprazole or pantoprazole, with a statistically insignificant difference.

Hypomagnesaemia in patients hospitalised in internal medicine is associated with increased mortality

Magnesium is the major intracellular divalent cation. Hypomagnesaemia is common among critically ill patients; it's prevalence is not known in patients admitted to general internal medicine. We sought to quantify hypomagnesaemia, and attempted to correlate it with clinical outcomes in internal medicine patients. Retrospective chart review. Hypomagnesaemic patients admitted from 1 October 2010 through 18 November 2010 compared with normomagnesaemic patients. Laboratory tests, medical and demographic data were analysed. In 627 consecutive admissions, overall frequency of hypomagnesaemia was 20.1% (87 patients). Hypomagnesaemic patients were a little older (mean age of 75) and more likely to be women (62%). There was a significant difference in mortality between the normomagnesaemic group (7.2%) and the hypomagnesaemic group (17.2%) (p = 0.0067). There was also a significant difference for length of stay (5.00 ± 5.3 vs. 7.0 ± 8.2, p = 0.0001). The prevalence of hypomagnesaemia in internal medicine is very high. It is associated with higher mortality and longer hospital stay in our population. It can be a useful tool in predicting morbidity and mortality. Although no causal role can be defined for it at present, the low cost and minimal discomfort of measuring magnesium justifies its routine measurement and replacement in patients hospitalised in internal medicine.

An update on the importance of monitoring serum magnesium in advanced disease patients

Patients with advanced diseases are exposed to many causes of hypomagnesaemia, the most frequent being pharmacological causes through the administration of chemotherapy, antibiotics, proton pump inhibitors, and so on. The objective of this review is to demonstrate the importance of measuring magnesium levels in the blood of these patients. In the last decade, studies have been published showing a direct relationship between low levels of magnesium and nonspecific symptoms including pain that is difficult to control. Nevertheless, hypomagnesaemia is still being omitted as a differential diagnosis in many such patients. A review of recently published studies regarding the clinical presentation of hypomagnesaemia in patients with advanced cancer and other chronic diseases is presented. Many of the clinical conditions are reportedly alleviated with intravenous or even oral magnesium administration. The presence of nonspecific neurological signs and risk factors for hypomagnesaemia could serve as an indication that serum magnesium should be determined in these patients.

TYPE 2 DIABETES MELLITUS;

Objective: To determine frequency of Hypomagnesaemia in patients of type 2 diabetes mellitus in our population. DataSource: Random selection of DM II patients from Outpatient Department CMH, Kharian. Design: Cross sectional study. Setting:Combined Military Hospital Kharian, Department of Medicine. Duration of study: January 2011 to December 2011. Materials &amp;Methods: We selected outdoor patients of DM-2 from both gender between 40 to 70 yrs of age by random sampling. Those selected,were subjected to blood fasting and random glucose measurements as well as serum magnesium levels. Blood samples were collectedusing full aseptic measures and within one hour, samples were transported to Armed Forces institute of Pathology (AFIP) for analysis.Serum magnesium level estimation was done by timed endpoint method using calmagite dye. DXC 600 automated analyzer was used.The results were verified by Pathologist. Results: The overall frequency of Hypomagnesemia was 32.2% (124 out of the 385 subjects)using the cutoff value of less than 0.6mmol/l for Hypomagnesaemia, whereas 67.8% (261 out of the 385 individual) had normal serummagnesium levels. Conclusions: Significant number of patients with type 2 diabetes mellitus suffers from Hypomagnesaemia. Thesepatients have increased risk risk of poor Glycemic control and diabetic complications due to Hypomagnesemia. Therefore, it isrecommended that serum magnesium levels should be checked regularly in patients with type 2 diabetes mellitus and oral magnesiumreplacement should be done.

A retrospective analysis of any trends in magnesium level for patients on omeprazole 10 mg/5 ml oral suspension from January to June 2012 (inclusive) in response to the MHRA Drug Safety Update April 2012

AimsTo retrospectively analyse any trends in magnesium levels for patients on omeprazole 10 mg/5 ml suspension in response to Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update April...

Incidence and risk of hypomagnesemia in advanced cancer patients treated with cetuximab: A meta-analysis

Hypomagnesemia is a serious adverse event for patients treated with cetuximab, an inhibitor of endothelial growth factor receptor (EGFR). However, no significant association has yet been established between cetuximab and hypomagnesemia in randomized controlled clinical trials (RCTs). The present study conducted a systematic review and meta-analysis of published RCTs to assess the overall risk of hypomagnesemia associated with cetuximab. PubMed, the Cochrane Central Register of Controlled Trials, Embase and the American Society of Clinical Oncology conferences were searched for relevant RCTs. Quantitative analysis was carried out to evaluate the association between hypomagnesemia and cetuximab. A total of 7,045 patients with a variety of advanced cancers from 10 trials were included in the analysis. The overall incidence of grade 3/4 hypomagnesemia in patients receiving cetuximab was 3.9% [95% confidence interval (CI), 2.6–4.3%]. Patients treated with cetuximab had a significantly increased risk of grade 3/4 hypomagnesemia compared with patients treated with control medication, with a relative risk (RR) of 8.60 (95% CI, 5.08–14.54). Risk was observed to vary with tumor type. The study concluded that cetuximab is associated with a significant risk of hypomagnesemia in patients with advanced cancer receiving concurrent chemotherapy.

Proton pump inhibitors and hypomagnesemia: a rare but serious complication

Proton pump inhibitors (PPIs) promote hypomagnesemia through loss of active Mg(2+) absorption via transient receptor potential melastatin-6 and -7 (TRPM6/7). Danziger et al. confirm the association of PPIs with hypomagnesemia in patients hospitalized at a tertiary medical center. They found that patients taking PPIs, compared with those receiving histamine-2 antagonists or no acid-suppressive medications, had a decline in serum Mg(2+) after adjusting for several clinical and laboratory factors. The effect was seen only in those concomitantly receiving diuretics.

Perioperative Therapeutic Plasmapheresis

Perioperative Therapeutic Plasmapheresis

ACUTE CORONARY SYNDROME;

Introduction: Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cationafter potassium. Magnesium plays a fundamental role in many functions of the cell, including energy transfer, storage, and uses protein,carbohydrate, and fat metabolism; maintenance of normal cell membrane function; and the regulation of parathyroid hormone (PTH)secretion. Objective: To determine the frequency of hypomagnesaemia in patients presenting with acute coronary syndrome (ACS).Design: Cross -sectional study. Place and duration: Coronary Care Units and medical ward in Allied Hospital Faisalabad, from 26-01-2010 to 25-07-2010. Settings: The study was conducted in medical unit II and coronary care unit of Allied Hospital Faisalabad. SampleSize: Sample size was calculated by using WHO sample size calculator taking confidence level 95%, population proportion 7.7% andrequired precision 4%. Sample size n = 171. Sampling Technique: Non-probability consecutive sampling. Method: A total of 171patients fulfilling the criteria of ACS admitted in M-II and CCU were enrolled in the study, demographic details, history and clinicalexamination of the patients were recorded. Blood sample was collected in estimation of serum magnesium level. Results: In this study themean serum magnesium was 1.59 ±8.380 in males and 1.56±7.678 in females. Among the 171 acute coronary syndrome patients, 14(8.2%) were diagnosed with hypomagnesaemia. There were 8 (8.8%) male and 6(7.5%) female patients. 157 (91.8%) patients did nothave hypomagnesaemia out of 83 (91.2%) were male and 74 (92.5%) were female patients. There was male predominance. Male to maleratio was 1.33:1. Conclusions: The results showed that frequency of hypomagnesaemia in acute coronary syndrome was significantlyhigh and comparable to other studies. There was male preponderance. However, there was variation in the occurrence ofhypomagnesaemia in acute coronary syndrome. Early assessment of serum magnesium concentration is needed in acute coronarysyndrome in order to implement proper magnesium supplementation.