Magnesium Replacement Research Articles

Multifaceted interventions to reduce acute exacerbations in elderly asthmatics.

BackgroundAlthough many risk factors are known to be associated with poor asthma outcomes in the elderly, the literature on the effect of risk factor control on asthma outcomes in the elderly is very sparse.ObjectiveTo evaluate the role of multifaceted interventions in reducing acute exacerbations in elderly asthmatics.MethodsA total of 100 subjects were randomly selected from our prospective cohort of elderly asthmatics aged 65 years or older and were provided multifaceted intervention for 1 year. Our multifaceted interventions included repeated education on asthma and inhaler technique for patients and their caregivers, provision of an action plan to cope with acute exacerbations, short message service to prevent follow-up losses, and oral replacement of magnesium. The primary outcome was an acute asthma exacerbation rate compared to the previous year.ResultsNinety-two subjects completed this study, although only 58 subjects continued to take magnesium. Compared to the previous year, the acute asthma exacerbation rate showed a significant reduction from 67% to 50% (p = 0001) and significant improvement was observed in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) (p = 0.04, p = 0.036 for each). Interestingly, a subgroup analysis revealed that predicted value of FEV1 increased significantly in subjects who continued to take magnesium from 79.6% to 87.1% (p = 0.008).ConclusionTo reduce acute exacerbations in elderly asthmatics, a multifaceted approach in increase medical awareness, proficiency and adherence to inhaler, assistance of caregivers and correction of micronutrients deficiency is likely to be effective. In addition, a continuous oral replacement of magnesium may increase FEV1 in elderly asthmatics.

Celiac Disease: aA Rare Cardiac Sequel

We explore the case of a 52-year-old woman who was transferred to our facility with recurrent torsade de pointes requiring repeated defibrillations. She had no previous medical history nor did she report any clear emotional or stressful triggers. In transit there were 14 episodes of polymorphic ventricular tachycardia, 11 of which required defibrillation. Her presenting electrocardiogram showed sinus rhythm with wide spread T-wave inversions and a QTc of 544 ms. In transit she was treated with intravenous potassium and magnesium. On arrival an isoprenaline infusion was commenced, which stabilised the patient. Coronary angiography showed non–obstructive disease with the left ventricular (LV) gram showing mid-wall variant Takotsubo cardiomyopathy. Bedside echocardiography showed low–normal LV systolic function of 55%, with no significant valvulopathy. Cardiac magnetic resonance imaging showed the resolving Takotsubo cardiomyopathy with no evidence of infiltrative disease. Despite clinical improvement, she had persistent hypomagnesaemia. Cardiomyopathy screening and investigations for hypomagnesaemia returned unremarkable with the exception of a strongly positive coeliac serology. With beta blockade, aggressive magnesium replacement, and gluten avoidance her QTc shortened and episodes of polymorphic ventricular tachycardia also settled as a consequence. She was discharged when stable and at the 6-month follow-up she remained asymptomatic with a resolution of her prolonged QT interval. This case identifies coeliac disease as a cause of severe electrolyte disturbances that resulted in recurrent torsade de pointes and Takotsubo cardiomyopathy that was treated conservatively (Figure 1, Figure 2). Figure 2Takotsubo LV gram. View Large Image Figure Viewer Download Hi-res image

Deficiencies of Magnesium Replacement in the Critically Ill.

Deficiencies of Magnesium Replacement in the Critically Ill.

Activity inhibition and crystal polymorphism induced by active-site metal swapping.

The Arenaviridae family is one of the two RNA viral families that encode a 3'-5' exonuclease in their genome. An exonuclease domain is found in the Arenaviridae nucleoprotein and targets dsRNA specifically. This domain is directly involved in suppression of innate immunity in the host cell. Like most phosphate-processing enzymes, it requires a divalent metal ion such as Mg2+ (or Mn2+) as a cofactor to catalyse nucleotide-cleavage and nucleotide-transfer reactions. On the other hand, calcium (Ca2+) inhibits this enzymatic activity, in spite of the fact that Mg2+ and Ca2+ present comparable binding affinities and biological availabilities. Here, the molecular and structural effects of the replacement of magnesium by calcium and its inhibition mechanism for phosphodiester cleavage, an essential reaction in the viral process of innate immunity suppression, are studied. Biochemical data and high-resolution structures of the Mopeia virus exonuclease domain complexed with each ion are reported for the first time. The consequences of the ion swap for the stability of the protein, the catalytic site and the functional role of a specific metal ion in enabling the catalytic cleavage of a dsRNA substrate are outlined.

Effectiveness and Safety of Magnesium Replacement in Critically Ill Patients Admitted to the Medical Intensive Care Unit in an Academic Medical Center: A Retrospective, Cohort Study.

"Rules of thumb" for the replacement of electrolytes, including magnesium, in critical care settings are used, despite minimal empirical validation of their ability to achieve a target serum concentration. This study's purpose was to evaluate the effectiveness and safety surrounding magnesium replacement in medically, critically ill patients with mild-to-moderate hypomagnesemia. This was a single-center, retrospective, observational evaluation of episodes of intravenous magnesium replacement ordered for patients with mild-to-moderate hypomagnesemia (1.0-1.9 mEq/L) admitted to a medical intensive care unit from May 2014 to April 2016. The primary effectiveness outcome, achievement of target serum magnesium concentration (≥2 mEq/L) compared to expected achievement using a "rule of thumb" estimation that 1 g intravenous magnesium sulfate raises the magnesium concentration 0.15 mEq/L, was tested using 1-sample z test. Logistic regression analysis was conducted to assess the effect of infusion rate on target achievement. Of 152 days on which magnesium replacements were provided for 72 patients, a follow-up serum magnesium concentration was checked within 24 hours in 89 (58.6%) episodes. Of these 89 episodes, serum magnesium concentration reached target in only 49 (59.8%) episodes compared to an expected 89 (100%; P < .0001). There was no significant association between infusion rate and achievement of the target serum magnesium concentration (odds ratio: 0.962, 95% confidence interval: 0.411-2.256). Medically, critically ill patients who received nonprotocolized magnesium replacement achieved the target serum magnesium concentration less frequently than the "rule of thumb" estimation predicted.

Efficacy of Magnesium Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Meta-analysis.

ObjectiveTo evaluate if magnesium supplementation, in addition to standard therapy, improves fasting blood sugar (FBS) and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) compared to placebo or other comparator.MethodologyWe searched MEDLINE/PubMed, Cochrane Library, Acta Medica Philippina, Health Research and Development Information Network (HERDIN) and references of reviewed journals from 1966 to July 2015 using the following search terms: “magnesium” OR “magnesium supplementation” OR “magnesium replacement”, AND randomized controlled trial AND diabetes OR diabetes mellitus OR non-insulin dependent diabetes mellitus OR diabetic OR diab* (with MeSH, where available). Studies were retrieved and rated independently using the standards provided by The Cochrane Collaboration. High quality trials were included in a systematic review and meta-analysis.ResultsOf the 689 records screened, 10 studies were included in the qualitative synthesis and 7 studies in the meta-analysis. Pooled data showed a non-significant trend towards improvement in glycemic control in the magnesium-treated group (mean difference -0.19, CI -0.58 to 0.21). There was a stronger but still non-significant trend in T2DM patients with hypomagnesemia (mean difference -1.16, CI -2.92 to 0.6).ConclusionRoutine magnesium supplementation for improvement in glycemic control in T2DM patients cannot be recommended based on data from included studies in this meta-analysis.

Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

Background/Aims: Magnesium is an essential mineral for many metabolic functions. There is very little information on the effect of magnesium supplementation on metabolic profiles of chronic kidney disease (CKD) patients. The aim of this study was to assess the influence of magnesium supplementation on metabolic profiles of pre-diabetic, obese and mild-to-moderate CKD patients with hypomagnesemia. Methods: A total of 128 hypomagnesemic, pre-diabetic and obese patients with an estimated glomerular filtration rate between 90 and 30 ml/min/1.73m² were enrolled in a randomised, double-blind, placebo-controlled trial. Patients in the magnesium group received 365 mg of oral magnesium (n = 57) once daily for 3 months, while patients in the control group received a placebo (n = 61), also once daily for 3 months. Hypomagnesemia is defined by a serum magnesium level <1.8 mg/dl in males and <1.9 mg/dl in females; obesity is defined as a body mass index ≥30 kg/m²; and pre-diabetes is defined as fasting plasma glucose ≥100 but <126 mg/dl. The primary end point of the study was the change in insulin resistance measured by the homeostastic model assessment for insulin resistance (HOMA-IR). Results: At the end of follow-up, insulin resistance (-24.5 vs. -8.2%, P = 0.007), HOMA-IR index (-31.9 vs. -3.3%, P < 0.001), hemoglobin A1c (-6.6 vs. -0.16%, P < 0.001), insulin (-29.6 vs. -2.66%, P < 0.001), waist circumference (-4.8 vs. 0.55%, P < 0.001) and uric acid (-0.8 vs. 2.2%, P = 0.004) were significantly decreased in terms of mean changes; albumin (0.91 vs. -2.91%, P = 0.007) and magnesium (0.21 ± 0.18 vs. -0.04 ± 0.05 mg/dl, P < 0.001) were significantly increased in those taking magnesium compared with a placebo. The decrease in metabolic syndrome (-10.5 vs. -4.9%, P = 0.183), obesity (-15.7 vs. -8.2%, P = 0.131), pre-diabetes (-17.5 vs. -9.8%, P = 0.140), and systolic (-5.0 ± 14.8 vs. 0.22 ± 14.9 mm Hg, P = 0.053) and diastolic (-3.07 ± 9.7 vs. 0.07 ± 9.6 mm Hg, P = 0.071) blood pressure did not achieve to a significant level after study. Conclusion: Our data support the argument that magnesium supplementation improves the metabolic status in hypomagnesemic CKD patients with pre-diabetes and obesity.

MON-P256: The Impact of Standardised Protocols to Guide Intravenous Magnesium and Phosphate Replacement in Non-Critically Ill Surgical Patients Requiring Parenteral Nutrition Support

MON-P256: The Impact of Standardised Protocols to Guide Intravenous Magnesium and Phosphate Replacement in Non-Critically Ill Surgical Patients Requiring Parenteral Nutrition Support

Successful Treatment of Aluminum Phosphide Poisoning with Continuous Veno-venous Hemofiltration: A Case Report

Address for Correspondence: Ayca Acikalin, Department of Emergency Medicine, Cukurova University School of Medicine, Adana, Turkey E-mail: aycaacikalin@yahoo.com ©Copyright 2016 by Emergency Physicians Association of Turkey Available online at www.jemcr.org Introduction Aluminum phosphide (AP) is a pesticide that has been used since the 1940s (1). It is a metal phosphide compound (Na3P, AlP) and is used as a rodenticide and insecticide. AP in an evaporable tablet form is used in wheat storage to reduce the number of mice attacks. This form causes fatalities, in suicidal exposure in particular. In countries such as Turkey, Iran, and India, public awareness of deadly exposure results in oral intake during suicide attempts (1). Gastric hydrochloric acid (HCl) causes the release of phosphine in the stomach after swallowing metal phosphide compounds. Phosphine induces cellular lipid peroxidation by means of the inhibition of mitochondrial cytochrome oxidase and oxygen utilization. This influence usually presents with hypotension, acidosis, and multiple organ failure (MOF) resistant to treatment. Mortality is extremely high and there is no identified antidote. Gastric irrigation with potassium and the replacement of intravenous magnesium have been suggested for treatment (1).

Impact of intravenous magnesium infusion rate during ambulatory replacements on serum magnesium concentrations after allogeneic stem cell transplant.

For an outpatient cancer center to operate efficiently, optimizing the use of chair time is essential. Allogeneic hematopoietic cell transplant (allo-HCT) recipients are seen frequently in this setting after hospital discharge and regularly for several months thereafter. Aggressive electrolyte replacement is commonly required in these patients, primarily due to renal wasting with calcineurin inhibitor use. Frequent intravenous (IV) magnesium repletion, requiring several hours of infusion time, is often needed in these patients to adequately manage their magnesium deficiencies. The purpose of this study is to explore the impact of extending the infusion rate of intravenous magnesium sulfate on the frequency and degree of IV magnesium replacements required in allo-HCT recipients. We conducted a retrospective study to compare two cohorts of patients administered IV magnesium sulfate at a rate of 4g/1h versus 4g/2h. A total of 103 continuous patients were assessed in two groups as cohort 1 at the 4g/1h rate and cohort 2 at the 4g/2h rate. Cohort 1 required less IV magnesium per outpatient visit (median 2.2 vs. 2.9g/visit, P = 0.0211) and less total IV magnesium replacement through day +100 (median 68 vs. 85g, P = 0.0479) than cohort 2. These data suggest that there is no apparent benefit of prolonging magnesium infusion from 1 to 2h in our outpatient allo-HCT population.

Management of Epidermal Growth Factor Receptor Inhibitor-Induced Hypomagnesemia: A Systematic Review

BackgroundDespite occurring in 30% of patients, there are no evidence-based guidelines on the management of epidermal growth factor receptor inhibitor (EGFRI)-induced hypomagnesemia. Based on expert opinion, severe hypomagnesemia should be treated by intravenous magnesium replacement. A systematic review of published data of intervention on EGFRI-induced hypomagnesemia was performed. MethodsArticles from 1960 to March 2015 were identified from Medline, Embase, Cochrane Central Register of Controlled Trials, and PubMed using a peer-reviewed systematic search strategy. Eligible studies included randomized controlled trials or observational studies that evaluated management of hypomagnesemia in adult patients treated with EGFRIs. Risk factors for severe hypomagnesemia were also assessed. The quality of included studies was rated using Jadad scores. ResultsA total of 1327 references were identified, and 6 studies, involving 486 patients, met inclusion criteria for analysis. There were no randomized controlled trials, and all included studies were of poor quality. From the studies included in this review, severity of EGFRI-induced hypomagnesemia was associated with length of EGFRI treatment, concomitant platinum chemotherapy, increasing age, and baseline magnesium concentration. In most patients with grade 3 or 4 hypomagnesemia, high-dose intravenous magnesium replacement did not achieve sustainable magnesium repletion beyond 72 hours. Oral magnesium supplementation was not effective or tolerable. Severe hypomagnesemia has been associated with tachycardia and mental alteration. After discontinuation of EGFRI therapy, hypomagnesemia generally resolves within weeks to months. ConclusionsThere is an absence of high-quality evidence for the management of EGFRI-induced hypomagnesemia. As hypomagnesemia is often refractory to frequent intravenous or oral replacement, there is a need for prospective trials of new interventions for this common toxicity.

Cadmium toxicity investigated at the physiological and biophysical levels under environmentally relevant conditions using the aquatic model plant Ceratophyllum demersum.

Cadmium (Cd) is an important environmental pollutant and is poisonous to most organisms. We aimed to unravel the mechanisms of Cd toxicity in the model water plant Ceratophyllum demersum exposed to low (nM) concentrations of Cd as are present in nature. Experiments were conducted under environmentally relevant conditions, including nature-like light and temperature cycles, and a low biomass to water ratio. We measured chlorophyll (Chl) fluorescence kinetics, oxygen exchange, the concentrations of reactive oxygen species and pigments, metal binding to proteins, and the accumulation of starch and metals. The inhibition threshold concentration for most parameters was 20nM. Below this concentration, hardly any stress symptoms were observed. The first site of inhibition was photosynthetic light reactions (the maximal quantum yield of photosystem II (PSII) reaction centre measured as Fv /Fm , light-acclimated PSII activity ΦPSII , and total Chl). Trimers of the PSII light-harvesting complexes (LHCIIs) decreased more than LHC monomers and detection of Cd in the monomers suggested replacement of magnesium (Mg) by Cd in the Chl molecules. As a consequence of dysfunctional photosynthesis and energy dissipation, reactive oxygen species (superoxide and hydrogen peroxide) appeared. Cadmium had negative effects on macrophytes at much lower concentrations than reported previously, emphasizing the importance of studies applying environmentally relevant conditions. A chain of inhibition events could be established.

Proton Pump Inhibitor Use and Magnesium Concentrations in Hemodialysis Patients: A Cross-Sectional Study.

Magnesium concentration is a proven predictor of mortality in hemodialysis patients. Recent reports have indicated that proton pump inhibitor (PPI) use affects serum magnesium levels, however few studies have investigated the relationship between PPI use and magnesium levels in hemodialysis patients. This study aimed to clarify the association between PPI use and serum magnesium levels in hemodialysis patients. We designed this cross sectional study and included 1189 hemodialysis patients in stable condition. Associations between PPI and magnesium-related factors, as well as other possible confounders, were evaluated using a multiple regression model. We defined hypomagnesemia as a value < 2.0 mg/dL, and created comparable logistic regression models to assess the association between PPI use and hypomagnesemia. PPI use is associated with a significantly lower mean serum magnesium level than histamine 2 (H2) receptor antagonists or no acid-suppressive medications (mean [SD] PPI: 2.52 [0.45] mg/dL; H2 receptor antagonist: 2.68 [0.41] mg/dL; no acid suppressive medications: 2.68 [0.46] mg/dL; P = 0.001). Hypomagnesemia remained significantly associated with PPI (adjusted OR, OR: 2.05; 95% CI: 1.14–3.69; P = 0.017). PPI use is associated with an increased risk of hypomagnesemia in hemodialysis patients. Future prospective studies are needed to explore magnesium replacement in PPI users on hemodialysis.

A Multifaceted Approach to Reduce Acute Exacerbations in Elderly Asthmatics

SESSION TITLE: Allergy and Airway Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: In our previous study, we have learned that factors related with acute exacerbations in elderly asthmatics were complex, for example, poor adherence and inhaler technique, depression, and magnesium deficiency. In this prospective study, we aimed to evaluate the role of a multifaceted approach in reducing acute exacerbations in elderly asthmatics. METHODS: A total of 100 subjects were randomly selected from our prospective cohort of elderly asthmatics aged 65 years or older. Our multifaceted approach included; repeated education on asthma and inhaler technique, provision of an action plan to cope with acute exacerbations, short message service to prevent follow-up losses, and oral replacement of magnesium. The primary outcome was an acute asthma exacerbation which comprised at least one of the followings; use of systemic corticosteroids for at least 3 days, unscheduled visit of outpatient clinic, and hospitalization or emergency room visit. The intervention period was one year and acute asthma exacerbation rate was compared to that of one year prior to this study. RESULTS: Ninety-two subjects completed this study, although only 58 subjects continued to take magnesium. Compared to one year prior to this study, the acute asthma exacerbation rate showed a significant reduction from 67% to 50% (McNemar's test; P = 0001). Interestingly, a subgroup analysis revealed that predicted value of forced expiratory volume in one second (FEV1) increased significantly in subjects who continued to take magnesium from 79.9% to 87.1% (P = 0.008). CONCLUSIONS: To reduce acute exacerbations in elderly asthmatics, a multidimensional approach to increase medical awareness, inhaler technique and adherence is essential. In addition, a continuous oral replacement of magnesium may increase FEV1 in elderly asthmatics. CLINICAL IMPLICATIONS: As the world is aging, asthma in the elderly is getting more attention. This study provides a useful strategy in managing acute exacerbations in elderly asthmatics. DISCLOSURE: The following authors have nothing to disclose: Suh-Young Lee, Heung-Woo Park, Woo-Jung Song, Sang-Heon Cho No Product/Research Disclosure Information

Magnesium and disturbances in carbohydrate metabolism.

Magnesium is actively involved in a number of metabolic reactions as an important co-factor, with special emphasis on carbohydrate metabolism. After a brief overview of the regulation of intra- and extracellular magnesium, the present review first describes the regulatory role of magnesium in important metabolic pathways involved in energy metabolism and glycaemic control. Next the clinical significance of hypomagnesaemic conditions with regard to the management of glucose in prediabetic stages, such as insulin resistance/impaired glucose tolerance and in type 2 diabetes mellitus are characterized. Cross-sectional as well as longitudinal studies suggest that a reduced dietary magnesium intake serves as a risk factor for the incidence of both impaired glucose regulation and type 2 diabetes. Mechanisms that might be responsible for diabetes-associated hypomagnesaemia are discussed. Furthermore, the role of hypomagnesaemia in the development and progression of chronic diabetic complications are addressed. Finally, the available literature on the effects of magnesium supplementation on glycaemic control parameters during prediabetic conditions (preventive approach) as well as type 2 diabetes mellitus (therapeutic approach) are reviewed systematically. There is considerable evidence that chronic magnesium supplementation may delay the progression from impaired glucose regulation to type 2 diabetes; however, the effects of oral magnesium supplementation as an adjunct therapy for type 2 diabetes are quite heterogeneous with respect to the various measures of glycaemic control. The results of this review suggest a requirement for critical consideration of the pros and cons of magnesium replacement therapy, based on variables such as magnesium status, stage of disease and glycaemic control.

Severe Hypocalcemia Induced by a Single Dose of Denosumab in a Patient with Osteomalacia Secondary to Long Standing Vitamin D Deficiency

Objective: Denosumab is a human monoclonal antibody that inhibits osteoclastic bone resorption via inhibition of RANKL. Hypocalcemia is a known risk of denosumab, but it can be very severe and resistant to treat when administered without adequate replacement of calcium and vitamin D. Methods: 32-year-old lady with history of rickets secondary to vitamin D deficiency was diagnosed with osteoporosis on DEXA scan and prescribed denosumab. She presented to ER within 24 hours with carpo-pedal spasms and was found to be severely hypocalcemic with ionized calcium of 2.2mg/dL (4.7- 5.3 mg/dl) and total calcium of 4.7 mg/dL (8.5-10.5 mg/dl). Her vitamin D levels and magnesium levels were also low. Her hypocalcemia was very resistant to treatment and required aggressive replacement of calcium and magnesium along with vitamin D and calcitriol. Results: We hereby report a case of life threatening hypocalcemia in a patient with vitamin D deficiency that occurred after administration of denosumab. Treatment required 130 grams of calcium, 48 grams of magnesium and 500,000 units of vitamin D with 10 mcg of calcitriol over a period of 10 days. Conclusion: Thorough evaluation for secondary causes of low bone density should be done prior to administering antiresorptive therapy in subjects suspected to have osteoporosis. We also emphasize that hypocalcemia can be extremely resistant to treatment when there is concomitant magnesium deficiency and if present should be replaced aggressively in subjects with hypocalcemia.

Magnesium protects against cisplatin-induced acute kidney injury without compromising cisplatin-mediated killing of an ovarian tumor xenograft in mice.

Cisplatin, a commonly used chemotherapeutic for ovarian and other cancers, leads to hypomagnesemia in most patients and causes acute kidney injury (AKI) in 25-30% of patients. Previously, we showed that magnesium deficiency worsens cisplatin-induced AKI and magnesium replacement during cisplatin treatment protects against cisplatin-mediated AKI in non-tumor-bearing mice (Solanki MH, Chatterjee PK, Gupta M, Xue X, Plagov A, Metz MH, Mintz R, Singhal PC, Metz CN. Am J Physiol Renal Physiol 307: F369-F384, 2014). This study investigates the role of magnesium in cisplatin-induced AKI using a human ovarian tumor (A2780) xenograft model in mice and the effect of magnesium status on tumor growth and the chemotherapeutic efficacy of cisplatin in vivo. Tumor progression was unaffected by magnesium status in saline-treated mice. Cisplatin treatment reduced tumor growth in all mice, irrespective of magnesium status. In fact, cisplatin-treated magnesium-supplemented mice had reduced tumor growth after 3 wk compared with cisplatin-treated controls. While magnesium status did not interfere with tumor killing by cisplatin, it significantly affected renal function following cisplatin. Cisplatin-induced AKI was enhanced by magnesium deficiency, as evidenced by increased blood urea nitrogen, creatinine, and other markers of renal damage. This was accompanied by reduced renal mRNA expression of the cisplatin efflux transporter Abcc6. These effects were significantly reversed by magnesium replacement. On the contrary, magnesium status did not affect the mRNA expression of cisplatin uptake or efflux transporters by the tumors in vivo. Finally, magnesium deficiency enhanced platinum accumulation in the kidneys and renal epithelial cells, but not in the A2780 tumor cells. These findings demonstrate the renoprotective role of magnesium during cisplatin AKI, without compromising the chemotherapeutic efficacy of cisplatin in an ovarian tumor-bearing mouse model.

Reversible cerebellar syndrome induced by hypomagnesemia

AbstractMagnesium is the second most abundant intracellular cation, and is involved in a multitude of cellular enzymatic reactions that are essential for life. Hypomagnesemia has been associated with various neurological symptoms. We report an intriguing case of a 68‐year‐old woman with hypomagnesemia and cerebellar syndrome associated with a transient lesion of the cerebellar vermis selectively involving the nodulus. Immediate replacement of magnesium determined the reversibility of the clinical picture.

Rare Earth Elements and High Molecular Weight Oil Compounds

Herein, there has been reviewed the behavior of rare earth elements in oil, extracts of alcohol-benzene mixture of oil and gas formation deposit and high macromolecular weight oil compounds - lubricants, resins and asphaltenes of different regions. There have been shown the differences in the fractionation of REE compositions and differential behavior of individual lanthanides in REE composition of the high macromolecular weight compounds (HMWC) of the produced and residual oils. Spectra of lanthanide distribution in the REE composition of the initial oil and its HMWC selection from the exploration drilling wells compared with the similar REE distributions in the high molecular weight oil compounds from development drilling wells. There has been emphasized the difference in the distribution of individual lanthanides in REE composition as a consequence of redox conditions changes in the deposits during the oil and gas fields exploitation. Geochemical study shows uncharacteristic behavior of individual lanthanides associated with the possibility of finding praseodymium (Pr) and terbium (Tb) in the tetravalent state, and the latter together with the neodymium (Nd) participate in the isomorphism with the replacement of magnesium and calcium, and its subsequent accumulation in the high molecular weight oil compounds. The obtained results became rationale for the consideration of the behavior of rare earth elements in high molecular weight compounds of produced and residual oils in the form of creating process data sheet of the deposit and in perspective for the future establishment of correlational relationship in time between the lanthanide distributions in the REE composition of high molecular weight compounds during the exploitation of the field with quantitative yield of fluids.

Impact of drug shortages on patients receiving parenteral nutrition after laparotomy.

Drug shortages, including parenteral nutrition (PN) product shortages, continue to increase and have a significant impact on healthcare. The extent to which product shortages affect bowel recovery and outcomes in patients receiving PN is unknown. The objective of this study is to examine the impact of extensive PN product shortages on patients receiving PN after laparotomy for bowel obstruction. A retrospective review was conducted for patients who underwent a laparotomy for small bowel obstruction and received PN postoperatively. Periods of limited and extensive PN product shortages at our institution were defined. PN therapy duration and composition, daily laboratory values, electrolyte supplementation, length of stay, and cost of hospitalization were recorded. Analyses using χ(2), Wilcoxon rank sum, log-rank, and t tests as appropriate were performed using SAS/STAT 9.2. Patients had longer hospital length of stays (20.0 vs 15.2 days; P = .04), trends toward longer PN therapy courses (8.8 vs 6.6 days; P = .13), and a 51% higher hospital cost during the extensive PN drug shortage period. Mean serum electrolyte concentrations were similar while the need for supplemental magnesium replacements increased during the extensive shortage period (75% vs 35%; P = .01). Supplemented patients also required higher doses of magnesium (2.7 vs 1.0 g; P < .01) and more laboratory draws during the extensive shortage period (59% vs 21% required ≥ 2 draws daily; P = .04). Fewer lipid calories were delivered during the extensive shortage period (2.4 vs 4.8 kcal/kg/d; P < .01). PN drug shortages have a negative impact on patient outcomes and require aggressive management strategies.