Normal Magnesium Levels Research Articles

SUN-207 MAGNESIUM LEVELS IN DIABETIC PATIENTS WITH END STAGE RENAL DISEASE (ESRD) IN ONE CENTER IN THE UNITED ARAB EMIRATES (UAE)

Diabetic kidney disease is the primary aetiology of ESRD in the UAE1. Low magnesium has been associated with poor glycaemic control and complications including diabetic kidney disease2. Large cohort studies from Japan and the United States reported low mean serum magnesium among 1.6-20% of their dialysis population3,4. Lower magnesium level was found to be more prevalent in diabetic patient in the Japanese cohort. ESRD patients with low magnesium and low normal magnesium had higher cardiovascular and non-cardiovascular mortality3,4. Aim: To compare the prevalence of magnesium disorders among diabetic patients with ESRD and non-diabetic patients with ESRD. The study is a single centre cross sectional study that was conducted at Sheikh Khalifa Medical City (SKMC) dialysis centre in Abu Dhabi, UAE. Exclusion criteria included patients who do not regularly dialyse at our centre and those who had less than four readings of magnesium level during the study period. The study period was from January 2017 to December 2017. A total of 260 patients were included in the study. The majority (70%) of the patients were non Emirati nationals. 41% were females, and the mean age was 55 years. The mean magnesium among our patients was 0.98 mmol/L with a SD +/- 0.15. The normal reference range is 0.66-1.07 mmol/L (1.6-2.6 mg/dL). The 12 months mean magnesium readings were calculated for all the patients. None of our patients had a low average magnesium. 21.6% of our patients had high average magnesium levels, while 78.4% had normal average magnesium levels. 59% of Emirati patients compare to 40% of non-Emirati patients were diabetic. There was no statistically significant relationship between Magnesium level and DM status (0.14 respectively). None of our patients had an average low magnesium. There was no statistically significant difference between normal magnesium levels and being diabetic among dialysis patients in our centre.

Correlation between serum magnesium levels and diabetic retinopathy in type 2 diabetes mellitus

Background: In this study, an attempt has been made to find the correlation between Diabetic Retinopathy (DR) and serum magnesium in type 2 Diabetic Mellitus (DM) cases.Methods: Study was conducted in the department of General Medicine, GSL Medical College. Study protocol was approved by institutional ethical committee. All the non-critically ill type 2 DM individuals of all ages attended the outpatient services were included in the study. The reference range of Magnesium was taken as 1.7-2.4 mg/dL. Patients with low and normal Magnesium levels were categorized as cases and controls respectively. Statistical analysis was performed using SPSS software 21, Chi square test was used to compare the different qualitative variables; p<0.05 was considered as statistically significant.Results: A total of 163 individuals were included in the study, the mean age was 55.72 years, ranged between 39 to 75 years; male female ratio was 1.12. DR was diagnosed in 54% cases and low magnesium levels were detected in 40% cases; the difference was statistically not significant (p>0.05).Conclusions: Estimation of glycaemic levels and serum magnesium can help us predict the onset and progression of DR.

The Role of Magnesium in the Development of Cardiovascular Diseases and the Possibility of their Prevention and Correction with Magnesium Preparations (Part 1)

The article is devoted to the influence of magnesium on the homeostasis of the body and, in particular, on the cardiovascular system. It describes the importance of the presence and effects of magnesium on various key processes and functions occurring in the body. The reasons for the lack of magnesium and ways to replenish it both in the natural way (eating, certain foods) and magnesium preparations are considered. The article provides examples of large randomized studies that prove the importance of the influence of normal magnesium levels on human health in general and on the state of the cardiovascular system. These studies show how magnesium deficiency increases the risk of cardiovascular diseases and how it can be reduced. It is also shown which trace elements and vitamins are closely related to magnesium metabolism, and how they (in particular, potassium and vitamin B6) improve and facilitate the normalization of magnesium levels. It is noted how comorbidity decreases with the normalization of magnesium level – the higher the magnesium level in the blood plasma (closer to the upper limit and more), the less comorbidity and longer life expectancy. Magnesium is an absolutely essential ion and a good medicine. Magnesium deficiency and hypomagnesemia are quite common, difficult to diagnose (due to underestimation and rare level control) and accompany many diseases of the cardiovascular system and beyond. The widespread use of organic magnesium salts would improve the situation as a whole, due to their universal multiple effect on many processes in the body. This is an integral part of therapeutic and preventive measures in patients with already existing diseases and in people who do not have diseases, but who are at risk due to existing hypomagnesemia.

MON-320 CONN’S SYNDROME MASQUERADING AS NORMOTENSIVE HYPOKALEMIC PARALYSIS, WITH SUBSEQUENT KALIOPENIC NEPHROPATHY

Hypokalemic paralysis even without hypertension, can herald a diagnosis of primary hyperaldosteronism (PHA). This patient presented with hypokalemic paralysis without evidence of hypertension during the initial 2 – 3 years. Following a diagnosis of adrenal carcinoma, he developed features of chronic tubulointerstitial nephritis denoting kaliopenic nephropathy due to prolonged hypokalemia. A 34-year-old male with a history of muscle cramps since 2 – 3 years, presented with flaccid lower limb weakness causing difficulty in walking over 3 days. His s. potassium was 1.6 meq/L. He was normotensive with alkalosis, increased TTKG and normal magnesium levels. Past records didn’t reveal any evidence of anorexia, laxative or diuretic abuse. Initial USS scan didn’t reveal any adrenal masses. Creatinine was normal. A working differential of Gitlemann’s syndrome was made despite normal magnesium levels and urine calcium excretion. He was treated with high dose KCL with prompt recovery of his weakness. His CPK was 9600 mg/dl denoting hypokalemia-induced rhabdomyolysis. During follow up his compliance was poor. After 2 years he presented with hypokalemic paralysis and blood pressure of 170/100mmHg. Investigations revealed elevated serum aldosterone levels >1650 pg/ml; with suppressed serum renin 0.4 ng/L. 24-hr urinary VMA, 9am s. cortisol, thyroid test, dexa.Sup.T., DHEA levels, parathyroid hormone, calcium and phosphate levels were normal. USS scan followed by CECT abdomen on this occasion revealed a left heterogeneous suprarenal mass, measuring 5.8 x 4.8 cm with poor contrast enhancement, favoring an adrenal carcinoma. He underwent open left adrenalectomy, which resolved his hypokalemia. Histological findings were consistent with an adrenal cortical adenoma. Subsequently, creatinine rose to 1.7mg/dl. Renal biopsy revealed primary tubular interstitial nephritis with isometric vacuolations in proximal tubules without evidence of hypertensive nephrosclerosis, conforming a diagnosis of kaliopenic nephropathy. He didn’t attend the clinic for 9 months, and he presented again with leg weakness due to severe hypokalemia. USS scan and CT scan reveled recurrence of adrenal carcinoma with metastases. He’s followed up with weekly radiotherapy for his cancer recurrence. Prevalence of PHA is 5 – 20 % of hypertensive patients in current literature (1) (2). Normotensive PHA is exceedingly rare, with only about 20 cases reported so far (3). Differential for normotensive hypokalemic patients usually does not ponder PHA, which led to an initial presumptive diagnosis of Gitelmann’s syndrome in our patient. Therefore lack of hypertension in hypokalemic patients should not exclude primary aldosteronism. Primary aldosteronism presenting as a paralytic myopathy, although rare is well established in literature (4) (5). Rhabdomyolysis can often be missed in patients presenting with non-spinal metabolic paralysis associated with hypertension, as symptoms overlap. Tubular vacuoles in kaliopenia of adrenal origin was first observed by Conn and Louis (6). Although literature reveals that early changes are potentially reversible with resurrection of potassium deficit, recovery of damages due to chronic kaliopenia is deemed impossible. This case highlights the importance of investigating for PHA even in patients with normotensive hypokalemia when no other apparent cause is found.

MON-534 Reduced PTH Levels in Adolescents with Anorexia Nervosa: Implication for Kidney and Bone

Background: Patients with anorexia nervosa (AN) experience bone as well as kidney complications including low bone mineral density (BMD), increased fracture rate, kidney stones, hypercalciuria and chronic renal failure. However, the mechanisms of those complications are not fully understood (1). The aim of this study is to investigate the interrelationship of central measures of calcium vitamin D metabolism and bone and kidney health in adolescents with newly diagnosed AN. Methods: This is a cross-sectional study that included newly diagnosed adolescents with AN referred to the Eating Disorder Program (EDP) at the Hospital for Sick Children over a two-year period. In addition to demographic and auxiological data, information on vitamin D and calcium intake was obtained. BMD and blood and urine samples for central measures of calcium vitamin D metabolism were investigated. In addition to descriptive statistics, multiple linear regression was performed to examine the association between PTH and various predictors. Results: A total of 61 patients (55 female, 6 male, mean age 15.2 ± 1.56 years) were included. Overall levels of serum calcium, phosphate, magnesium and 25-hydroxyvitamin D (25OHD) were normal and urinary calcium to creatinine ratio was increased (0.87 ± 0.47mmol/mmol, normal<0.7). However, a novel observation was made regarding low PTH levels in 35% of this cohort (<22ng/L, normal 22-88ng/l (2)). Low PTH levels did not appear to be a result of partial or complete hypoparathyroidism (normal calcium and phosphate levels), oral calcium intake (no significant correlation, p= 0.59) or magnesium deficiency (normal magnesium levels). As previously described, a significant negative correlation between PTH and 25OHD levels below 100 nmol/L was noted (p=0.007). However, 25OHD levels in the range of 100-200 nmol/L, did not contribute to the lower PTH levels (p= 0.39). Mean lumbar spine (L2-4) BMD Z-score was -0.69 ± 1.14. Conclusion: This study indicates reduced PTH levels in 1/3 of adolescents with AN at presentation to a tertiary care EDP. As in previous studies (1), this data suggests that the reduction in PTH may be due to a subtle increase in ionized serum calcium resulting from reduced bone formation and reduced mineralization with ongoing bone resorption. Reduced PTH levels in these patients may contribute to both the renal and bone complications in AN.

SAT-497 Importance of OTC Medications in Hypercalcemia

Background: Calcium-alkali syndrome, formerly known as milk-alkali syndrome was a classic cause of hypercalcemia until newer therapies for peptic ulcer disease emerged is mostly seen today in osteoporosis prevention and secondary hyperparathyroid treatment in chronic kidney disease. Here we present the contemporary presentation as a result of the classic syndrome. Case: 57-year-old male, history of hypertension, type-2 diabetes, Hodgkin’s lymphoma in remission was admitted with lower abdominal pain and difficulty voiding. His vitals and physical exam were within normal limits. Medications included Janumet, Lipitor and Ramipril. Labs showed a white count of 15.3cells 103 /uL with a left shift and a normal hemoglobin level. Serum chemistry with BUN of 37mg/dl, creatinine at 3.86mg/dl, calcium at 15.3mg/dl, albumin level of 3.4g/dl, corrected to 15.5mg/dl, phosphorous was low at 1.6mg/dl with normal magnesium level of 1.7mg/dl. The patient had prior normal renal function and calcium levels. Lymphoma was highest on the differential for the hypercalcemia. Workup revealed intact PTH of 9.9pg/ml (Low), PTHrp at 12pg/ml (14-27), 1,25- dihydroxy vitamin D level of <8 pg/ml (Low), 25-hydroxy vitamin D at 14.9ng/ml (Low). Serum protein electrophoresis revealed elevated alpha-1 and alpha-2 proteins signifying an ongoing acute inflammation. ACE levels were low at 5U/L (9-67). TSH levels were normal. LDH levels were normal at 234U/L. Further questioning revealed that the patient took about 40 tablets of over the counter “Tums” for gastritis in the last 3 days. Tums contains 500 -1117mg elemental calcium/tablet. It has been noted that calcium absorption markedly increases in the gut with high intake of 10-15gms calcium/day despite suppressed calcitriol levels. Based on the above, the diagnosis of Milk-Alkali syndrome: modern presentation was made. The calcium was treated with aggressive hydration and counselling regarding excessive Tums usage. Removal of Tums restored normal calcium levels and renal function. The modern presentation differs from the classic in being an incidental discovery, as the patient is asymptomatic as in our case. Hypophosphatemia is common due to an absence of phosphate load unlike with milk. Hypomagnesemia could be present as the high calcium inhibits magnesium resorption. Treatment includes removal of the offending agent and isotonic saline infusion. Furosemide has been tried but it may cause hypocalcemia as the suppressed PTH is slow to respond. For the same reason bisphosphonates should be avoided. Conclusion: Calcium-Alkali-syndrome, a now uncommon classic cause of hypercalcemia presents with a reversible triad of non-PTH, noncalcitriol mediated hypercalcemia, metabolic alkalosis and renal insufficiency in the setting of excessive ingestion of calcium with an absorbable alkali. OTC medications should be included in the history to avoid missing this diagnosis.

Association of Magnesium Status with Poor Glycemic Control and Microangiopathic Complications (Neuropathy and Nephropathy) in Diabetic Patients in Dakar

Low serum magnesium level has been shown to be associated with diabetes mellitus and its complications. The objective of this study was to determine the magnesium status in our study population and its association with glycemic control and microangiopathic complications particularly neuropathy and nephropathy. This was a cross sectional and prospective study conducted among patients received as part of their follow-up at the Marc Sankale center of the Abass Ndao hospital in Dakar. For each patient, blood samples and 24h urine collection were performed. Hypomagnesemia was defined for Mg concentrations <17 mg/L and statistical analysis was performed using the XLSTAT 2018 software. A total of 106 diabetic patients were enrolled consisting of 93 type 2 diabetics and 13 type 1 diabetics. Eighty percent of patients had hypomagnesemia compared to 20% who had normal magnesium levels. We found a significantly higher mean HbA1c level in the group of hypomagnesemic patients compared to patients with normal magnesium levels (p = 0.02) and significant negative correlation between magnesium and HbA1c (r = - 0.20, p = 0.03). The frequencies of neuropathy and nephropathy were comparable between the two groups with respectively p = 0.12 and p = 0.28. Our study shows a high frequency of hypomagnesemia in both type 1 and type 2 diabetes and a significant correlation of this hypomagnesemia with poor glycemic control. No association has been found between magnesium and the microangiopathic complications, but it nevertheless alerts clinicians to the possible need for magnesium supplementation in the management of diabetic patients.

Magnesium: Are We Consuming Enough?

Magnesium is essential for maintaining normal cellular and organ function. In-adequate magnesium balance is associated with various disorders, such as skeletal deformities, cardiovascular diseases, and metabolic syndrome. Unfortunately, routinely measured serum magnesium levels do not always reflect total body magnesium status. Thus, normal blood magnesium levels eclipse the wide-spread magnesium deficiency. Other magnesium measuring methods, including the magnesium loading test, may provide more accurate reflections of total body magnesium status and thus improve identification of magnesium-deficient individuals, and prevent magnesium deficiency related complications.

The association between serum magnesium levels and community-acquired pneumonia 30-day mortality

BackgroundCommunity acquired pneumonia (CAP) is a common illness affecting hundreds of millions worldwide. Few studies have investigated the relationship between serum magnesium levels and outcomes of these patients. We aimed to study the association between serum magnesium levels and 30-day mortality among patients with CAP.MethodsRetrospective overview of patients hospitalized with CAP between January 1, 2010 and December 31, 2016. Participants were analyzed retrospectively in order to identify the risk factors for a primary endpoint of 30-day mortality. Normal levels of magnesium levels in our laboratory varies between 1.35 and 2.4 mg/dl.Results3851 patients were included in our cohort. Age > 75 years, blood urea nitrogen (BUN) > 20 mg/dl, hypoalbuminemia, and abnormal levels of magnesium were all associated with increased risk of 30-day mortality. Normal magnesium levels were associated with the lowest mortality rate (14.7%). Notably, within the normal levels, high normal magnesium levels (2–2.4 mg/dl) were correlated with higher mortality rates (30.3%) as compared to levels that ranged between 1.35–2 mg/dl (12.9%). Hypomagnesemia and hypermagnesemia were both associated with excess of 30-day mortality, 18.4 and 50%, respectively.ConclusionHypomagnesemia and hypermagnesemia on admission were associated with an increased rate of 30-day mortality among adult patients hospitalized with CAP. Interestingly, magnesium levels within the upper normal limits were associated with higher mortality.

Primary Hypoparathyroidism - Misdiagnosed as Epilepsy

Absent or inappropriately low intact parathyroid hormone along with hypocalcemia is the diagnostic criterion of hypoparathyroidism. Clinically, hypoparathyroidism manifests predominantly as neuromuscular dysfunction caused by hypocalcemia. We present here a case of hypoparathyroidism wrongly and ineffectively treated as epilepsy for six years prior to reporting to our hospital. Hypoparathyroidism was diagnosed in our patient on the basis of low serum calcium (ionized and total), high phosphate and very low IPTH levels in face of normal magnesium levels along with radiological evidence of cerebral calcification.J MEDICINE JUL 2018; 19 (2) : 133-135

Gastrointestinal motility in critically ill patients

Up to 80% of all critically ill patients develop gastrointestinal dysfunction, predominantly gastrointestinal motility disorder. In critically ill patients, gastrointestinal dysfunction or gastrointestinal failure is associated with increased morbidity and mortality. Correct diagnosis and early start of treatment are essential and can influence the outcome. Therapeutic options are normal potassium and magnesium levels, restrictive fluid balance, improved gastrointestinal microcirculation, individual sedoanalgetic concepts and early enteral nutrition. In addition, numerous target-oriented medical therapeutic options are available.

Hypomagnesemia and clinical benefits of anti-EGFR monoclonal antibodies in wild-type KRAS metastatic colorectal cancer: a systematic review and meta-analysis

Hypomagnesemia is a recognized side-effect of cetuximab- or panitumumab-based chemotherapy for metastatic colorectal cancer (mCRC). The clinical relevance of hypomagnesemia is under debate. Thus, a systematic review and meta-analysis of retrospective studies and randomized clinical trials (RCTs) comparing hypomagnesemia with normal magnesium levels in wild-type KRAS mCRC was performed. One RCT, two retrospective studies, and two American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) conference presentations from phase III RCTs involving 1723 patients were included in this study. Patients with hypomagnesemia demonstrated better progression-free survival (PFS) (Hazard ratio [HR]: 0.64; 95% confidence interval [CI]: 0.47–0.88), overall survival (OS) (HR: 0.72; 95% CI: 0.53–0.92), and objective response rate (ORR) (Risk ratio [RR]: 1.81; 95% confidence interval [CI]: 1.30–2.52). By subgroup analysis, frontline, later lines or combination therapy with hypomagnesemia were associated with PFS benefits (HR: 0.78; 95% CI: 0.62–0.98; HR: 0.60; 95% CI: 0.40–0.90; HR: 0.62; 95% CI: 0.41–0.94, respectively). In patients with wild-type KRAS mCRC, hypomagnesemia is associated with better clinical benefits of PFS, OS and ORR when treated with cetuximab- or panitumumab-based chemotherapy. Future clinical trials should corroborate its predictive role.

The paleolithic ketogenic diet may ensure adequate serum magnesium levels

Author(s): Clemens, Zsofia, Dr. | Abstract: Introduction Magnesium plays an essential role in several enzymatic reactions. Its deficiency is known to be widespread and has been associated with a variety of pathological conditions characterized by chronic inflammation and/or oxidative stress. The connection between the metabolism of glucose and magnesium at the cell level is well-established. We hypothesize that magnesium deficiency in chronic conditions is primarily due to Western type carbohydrate based metabolism. In previous case studies we have shown that magnesium levels are normal on the paleolithic ketogenic diet. Here we assessed magnesium levels in a larger sample (n=50) to address whether the paleolithic ketogenic diet is able to ensure normal blood magnesium levels. Materials and Methods To assess magnesium levels in patients and healthy controls on the paleolithic ketogenic diet in a larger sample, we retrospectively analysed laboratory data obtained from 50 patients/subjects who were following the diet and were also not taking magnesium or other supplements. Correlation calculation was performed between magnesium and glucose levels. Results We found magnesium levels to be in the normal range in all but one patient/subject. There was a significant inverse correlation between glucose and magnesium levels. Discussion Our results indicate that the paleolithic ketogenic diet ensures normal magnesium levels in various pathological conditions as well as in healthy subjects. We believe that the high prevelance of magnesium deficiency reported earlier for a variety of chronic conditions is correlated with carbohydrate-based Western type nutrition rather than that of the chronic condition itself. We discuss underlying mechanisms.

Effects of Intraoperative Magnesium Sulfate Administration on Postoperative Tramadol Requirement in Liver Transplantation: A Prospective, Double-Blind Study.

Magnesium is an N-methyl-d-aspartate receptor blocker and is known to have analgesic effect. Hypomagnesemia can often be seen in liver transplantation and may be associated with higher morbidity and mortality. The objective of this study was to investigate the effects of intraoperative magnesium sulfate administration on postoperative tramadol requirement in liver transplant patients. Liver transplant patients >18 years of age were screened prospectively from October 2014 to April 2015. Of these, 35 randomly selected patients with normal blood magnesium level (≥1.8 mmol/L) were included in a control group and another 35 randomly selected patients with low magnesium level (<1.8 mmol/L) were given 50 mg/kg intravenous magnesium sulfate replacement in the last 30 minutes of the operation. All patients received standard anesthesia induction and maintenance. Patient's age, sex, body mass index, Model for End-Stage Liver Disease and Acute Physiology and Chronic Health Evaluation II scores, 24-hour tramadol requirement, mechanical ventilation duration, and time of 1st tramadol need were recorded. In the magnesium group, mean 24-hour total tramadol requirement (3.7 mg/kg/d) and duration of mechanical ventilation (6.3 h) were significantly lower and time of 1st tramadol need (17.5 h) was significantly higher than in the control group (P< .001 for each). In the multivariate analysis, duration of mechanical ventilation was decreased by the usage of magnesium sulfate (P< .001). Intraoperative use of magnesium sulfate in liver transplantation reduces the need for postoperative tramadol and duration of mechanical ventilation and therefore it is a candidate to be adjuvant agent.

Magnesium for Atrial Fibrillation, Myth or Magic?

Low magnesium levels have been implicated as a risk factor for the development of atrial fibrillation (AF).1 However, like many interventions before it, supplementing magnesium levels does not necessarily lead to a successful cardioversion or better prevention of AF in high-risk groups. This issue is clinically important in view of the high burden that AF poses, the increasing incidence of AF, and the association of AF with adverse long-term clinical outcomes.2 AF is not only prevalent in the general population (≈3%, with much higher rates in older patients) but also a frequent comorbidity and risk factor in patients with a range of cardiovascular conditions, including heart failure and after cardiac surgery.3,4 Identifying practical and effective methods for managing AF is a clinical imperative. See Article by Rajagopalan et al The attention on magnesium as a potential antiarrhythmic agent is founded on a small number of physiological assessments in human and animal models.5 Intravenous magnesium directly affects myocardial potassium channels, has voltage-dependent and indirect effects on calcium and sodium channels, prolongs the PR interval, and increases the refractory period of antegrade atrioventricular node conduction.6,7 However, although low serum magnesium levels were associated with incident AF in the ARIC study (Atherosclerosis Risk in …

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.

Impact of serum magnesium levels in critically ill elderly patients—A study in a rural teaching hospital

Background/PurposeMagnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium deficiency are lacking in India, especially in a rural setting. Here, we have correlated serum magnesium levels with outcomes in elderly patients admitted to the medical intensive care unit with respect to the length of intensive care unit stay, need for mechanical ventilatory support and its duration, and outcome (discharge/death). MethodsA prospective, observational study was conducted in patients aged 60 years and older, who had been admitted to the intensive care unit of the medicine department for over a year. The chi-square test was applied to correlate hypomagnesemia with the outcome. ResultsIn our study, 59.30% of the elderly patients had hypomagnesemia. Compared with patients with a normal magnesium level, hypomagnesemic patients had no correlation with the duration of medical intensive care unit stay (5.57±6.10 days vs. 5.61±5.55 days), but the need for mechanical ventilation (57.84% vs. 45.71%), rate of discharge from the intensive care unit or cure (60.28% vs. 71.42% ), rate of death (39.21% vs. 28.57%), and mean duration of ventilation (3.07±5.05 days vs. 2.15±3.46 days) were higher. However, no significant statistical difference was found between these groups. ConclusionHypomagnesemia was associated with a slightly higher mortality rate. Requirement and duration of ventilatory support were also higher, although not statistically significant. Hypomagnesemia was not found to have any impact on the duration of medical intensive care unit stay. Monitoring of serum magnesium levels may have prognostic and perhaps therapeutic implications in the elderly.

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.

Factors Associated With Changes in Magnesium Levels in Asymptomatic Neonates: A Longitudinal Analysis.

Background:Neonates and infants with hypomagnesemia present with seizures and psychomotor delay.Objectives:The present study evaluated the changes in magnesium (Mg) levels and factors associated with these in the first three days of life.Materials and Methods:We monitored 50 clinically asymptomatic neonates; they were not given any magnesium supplements even if they had hypomagnesemia at baseline. The variables analysed were: serum Mg; gestational age; birth weight; length; and the ponderal index. We used random effects (RE) models for longitudinal analysis of these data.Results:The mean standard deviation (SD) gestational age was 36.3 (3.6) weeks and the mean (SD) weight was 2604.2 (754.4) grams. About 31% of the neonates had hypomagnesemia (< 1.6 mg/dL) on day one; however, all had normal magnesium levels by day three of life (P < 0.001). At birth, after adjusting for intrauterine growth retardation status (IUGR), serum Mg levels were lower by 0.0097 mg/dL (95% CI: -0.019 to -0.0003) per 100 grams increase in weight of the neonate. After adjusting for IUGR status, the mean increase in the serum Mg levels was 0.14 mg/dL (95% confidence intervals [CI]: 0.10 to 0.18) per day. The per-day increase in magnesium levels was significantly higher in low birth weight babies (0.10, 95% CI: 0.01 to 0.18) compared with normal birth weight babies.Conclusions:Asymptomatic neonates may have a high prevalence of hypomagnesemia; however, the levels become normal without any magnesium supplementation. Even though regular monitoring of magnesium levels is useful, no supplements are required - particularly in clinically asymptomatic neonates.

Magnesium levels among critically ill elderly patients; mortality and morbidity correlation

Objectives: To evaluate the association between magnesium levels, morbidity and mortality in critically ill elderly patients admitted in ICU. Methods: A cross-sectional study was done on patients admitted to the intensive care unit (ICU) of the Geriatrics department at a University Hospital over 1.5 years period. Data collected included patients demographics and medical history, length of stay in the ICU. Lab tests included serum Magnesium on admission, serum sodium and potassium. In addition, the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Sequential Organ Failure Assessment (SOFA) score were determined at the day of admission. Results: A single center, cross sectional study was done on 100 patients who were admitted to the Geriatrics medical ICU at Ain Shams university Hospital in Cairo. At admission 23% of patients had low magnesium (Mg) level and 59% had normal magnesium level and 18% had high Mg level. The mean age of patients with hypomagnesaemia was 71.69 years old while those with normal magnesium level were 69.5 years old and that with hypermagnesaemia were 69.7 years old. The length of ICU stay was longer among patients with high Mg level (11.7 ± 14.4 days) and among those with normal magnesium level (7.6 ± 5.8 days) versus (7.5 ± 3.8 days) those with low Mg level, among the studied groups (55.6%) of patients with Hypermagnesaemia died versus (44.1%) of patients with normal Mg level. Among the studied groups, those with high Mg level were found to have higher APACHE II score (20.7 ± 7.4) and SOFA score (5.5 ± 3.6) than the other subjects. Significant positive correlation was found between mean Mg level and SOFA score. Conclusion: Development of hypermagnesaemia during an ICU stay is associated with bad prognosis. Monitoring of serum magnesium levels may have prognostic, and perhaps therapeutic, implications.