Total Serum Magnesium Research Articles

Magnesium: a kardio-renal viewpoint

Disturbances in magnesium homeostasis are frequent clinical conditions, particularly the prevalence of hypomagnesaemia is high. However, it remains an open question which laboratory method is optimal to assess the magnesium level in the body. Most frequently physicians measure total magnesium in serum. Many associative data from observational studies point towards an association between low magnesium levels and increased cardiovascular risk as well as increased mortality. Vice versa, normal-to-high magnesium levels in patients with advanced renal failure translate to a better outcome. The present review summarizes our knowledge on protective effects of magnesium. Additionally, we address the limited evidence supporting targeted magnesium supplementation.

Efeitos de dois protocolos de sedação sobre as variáveis bioquímicas em gatos

RESUMO A utilização de protocolos de sedação como auxílio na contenção de felinos para realização de coletas de sangue é de grande importância, porém a utilização de alguns fármacos pode alterar resultados e a interpretação deles. Por outro lado, a contenção física pode gerar intenso estresse, especialmente em felinos, o que também pode interferir nos resultados. Este estudo teve como objetivo avaliar exames de bioquímica clínica sob o uso de contenção física e química em gatos submetidos a dois protocolos de sedação. Foram utilizados 50 gatos, 26 fêmeas e 24 machos, sem raça definida, submetidos a contenção física e, imediatamente após, a dois protocolos de sedação, DB (dexmedetomidina 5µg/kg e butorfanol 0,3mg/kg) e DBC (dexmedetomidina 5µg/kg, butorfanol 0,3mg/kg e cetamina 3mg/kg), aplicados por via intramuscular. Amostras de sangue foram coletadas após a contenção física e, em seguida, após o uso de um dos protocolos de sedação. Foram avaliados: ureia, creatinina, alaninoaminotransferase (ALT), fosfatase alcalina, proteína sérica total (PST), albumina, globulinas, colesterol, triglicérides, cálcio, magnésio e cloretos de amostras de soro, lactato e glicose de amostras de plasma fluoretado. Foi encontrada diferença estatística entre grupos para albumina, triglicérides, PST e colesterol, com maiores valores sendo encontrados no grupo DBC. Entre momentos, houve diferença para colesterol e fosfatase alcalina, com maiores valores no momento contenção física somente no grupo DBC. Já a glicose teve maiores valores após a sedação em ambos os grupos. O estudo revelou que o uso destes protocolos implica restrições para alguns parâmetros bioquímicos aqui estudados e que suas interpretações devem ser avaliadas cuidadosamente.

Relationship between serum total magnesium and serum potassium in emergency surgical patients in a tertiary hospital in Ghana.

Potassium and magnesium are the two most abundant intra-cellular cations. They play pivotal roles in many essential biological processes. Deficiencies of these electrolytes are of clinical importance in hospitalised patients. To determine the relationship between serum total magnesium and potassium levels in adult patients requiring an emergency intra-abdominal surgery and the clinical utility of this relationship in the care of patients. A cross sectional study was conducted over a five month period at the Korle-Bu Teaching Hospital. All 101 adult patients admitted for emergency intra-abdominal surgery, who met the inclusion criteria and gave informed consent, were consecutively recruited and enrolled into the study. Patients' characteristics preoperative total serum magnesium, serum potassium and albumin levels were determined. Regression analysis and correlation coefficients were used to determine the relation between serum magnesium and potassium. Analysis was done using SPSS version 20. Mean serum total magnesium and serum potassium were 0.66±0.20mmol/L and 3.79±0.65mmol/L respectively. There was a significant but weak positive correlation between serum hypokalaemia and serum magnesium levels. Pearson's correlation coefficient (2 tailed) was 0.21, R(2)= 0.04, p = value 0.038. Analysis generated a regression model: [Mg] = 0.06[K] + 0.42mmol/L, with a p-value = 0.038. A mathematical relationship was found between serum total magnesium and serum potassium among adult patients who require emergency intra-abdominal surgery. However, it had limited clinical utility. None declared.

Modification of Total Magnesium level in pregnant Saudi Women developing gestational diabetes mellitus

BackgroundThe aim of our study is to measure total Magnesium in pregnant women screened for GDM and to compare total magnesium between whom were diagnosed having GDM and those having normal pregnancy. MethodsOur study is a prospective study involved 99 pregnant women referred to Maternity and Child Hospital Al Ahsa (Kingdom of Saudi Arabia) for 100g Oral Glucose Tolerance test. All included pregnant women were in their 24–28 weeks of gestation with free past medical history and were free for any medicine. A 100-g Oral Glucose Tolerance (OGTT) with total plasma magnesium measurement were done to all included women. All patient were followed tell delivery. ResultsAmong 99 patients enrolled in our study, GDM was diagnosed in 19 patients (19.2%). Fifteen patients have normal fasting glycaemia and were diagnosed having GDM on 100-g OGTT. Four patients have fasting glycaemia more than 126mg/dl (7mmol/l) confirming the diagnosis of GDM. Hypomagnesemia was confirmed in eight patients (8.08%). no one of them had GDM. The serum magnesium concentration in GDM women was lower that of normal pregnant women but the difference was not significant. (0.89±0.1 vs 0.92±0.2mmol/l, p=0.51). BMI, systolic and diastolic blood pressure were not significantly different between the pregnant women who developed or not gestational diabetes. ConclusionIn our study, the development of GDM cannot be explained by low total serum magnesium. The low total serum magnesium in patient diagnosed having GDM compared to whom free of GDM and the importance of magnesium in the genesis of insulin resistance should encourage more large trial to explain the exact role of magnesium in the pathophysiology of GDM.

Comparison of serum calcium and magnesium between preeclamptic and normotensive pregnant Nigerian women in Abakaliki, Nigeria

Background:Evidence suggests the involvement of calcium and magnesium metabolism in the pathophysiology of preeclampsia. However, findings from studies are heterogenous and inconsistent.Aim:The study aimed to compare the total serum calcium and magnesium levels in preeclamptic women with that of normotensive pregnant women.Subjects and Methods:A cross-sectional subjects of eighty pregnant women living in Abakaliki, Ebonyi state, South-East Nigeria, were recruited into the study. The present study compared serum calcium and magnesium in forty preeclamptic (cases) and forty normotensive (control) pregnant women matched for age, parity, and socioeconomic status. Serum calcium and magnesium levels were measured using atomic absorption spectrophotometer. Statistical analysis was done using SPSS Version 20 statistical software. Differences between means were compared using Student's t-test with P < 0.05 considered as statistically significant.Results:While the mean serum calcium was comparable between preeclamptic and normotensive pregnant women (13.99 [3.29] vs. 14.02 [5.68] μg/dl), the preeclamptic pregnant women have significantly (P < 0.001) lower serum magnesium in comparison to their normotensive counterparts (3.22 [1.05] vs. 4.15 [0.78]).Conclusion:It may be concluded that serum magnesium seems to play a crucial role in the pathophysiology of preeclampsia in this environment.

Hematological and biochemical parameter alteration after plateletpheresis donation

Background The plateletpheresis process is a great improvement in transfusion medicine, and it is thought to be generally safe to the donor. However, donors’ safety issues and the anticoagulant used during these procedures have not been fully explored. This study aimed at analyzing the significance of alteration in some hematological parameters, total calcium and total magnesium levels, in donors after plateletpheresis procedure. Materials and methods The plateletpheresis procedures were performed on 72 donors. Prehematological and posthematological values were analyzed, such as hemoglobin concentration, hematocrit, platelet, white blood cell, red blood cell, mean platelet volume, and platelet distribution width, as well as measured total serum calcium (tCa 2+ ) and magnesium levels (tMg 2+ ), at different time intervals during and after the procedure in all donors. Results After plateletpheresis procedures, we observed that the hemoglobin concentration, hematocrit%, and white blood cell count were highly significantly decreased ( P P P =0.036), without significant changes in platelet distribution width and red blood cell. In addition, there were significant decrease ( P Discussion Plateletpheresis procedures are very safe for donors; however, indicated biochemical and hematological parameters before and after the donation are definitely useful to establish postdonation reference ranges that are needed for carefully monitoring, retaining and following-up the donor, reviewing the repeated donations, and to protect donation safety by looking for the cumulative effects of these changes, as well as transfusion of blood products with higher-quality needs.

Total Serum Magnesium Level in ICU In-patients under Mechanical Ventilation

Since hypomagnesemia is the most common idiopathic unknown electrolyte disturbance among the ICU in-patients leading to increased ICU stay, prolonged mechanical ventilation, and increased treatment costs, this study aimed at investigating the total serum magnesium level of ICU patients under mechanical ventilation. This cross-sectional study was conducted on 100 ICU in-patients under mechanical ventilation hospitalized in Be'that Hospital in Hamedan, Iran, aged 16+ years with an APACHII score of <20. At first, the total serum magnesium level was measured on day 1, day 2, and at discharge, and its correlation with ICU stay and mechanical ventilation time was estimated. Our findings showed that on the first day, 43% of the patients had hypomagnesaemia, and 57% had normomagnesemia. On the second day, 23% of the patients had hypomagnesemia and 77% had normomagnesemia. Also, at discharge, 97% of the patients had normomagnesemia and 3% had hypermagnesemia. The ICU stay, mechanical ventilation time, and intubation of the hypomagnesemic patients were significantly higher than those of the normomagnesemics (P-value<0.05). Vigilant monitoring of the serum magnesium level in the ICU and prompt treatment lead to decreased ICU and hospital stay and reduced mechanical ventilation time.

Serum magnesium status among obese children and adolescents

Background and objectivesSerum magnesium is involved in the pathogenesis of obesity and its related diseases. The aim of the present study was to evaluate serum magnesium status in obese children and adolescents and to study its relationship with the degree of obesity and serum lipid profile. Design and settingsA cross-sectional study was conducted at the general pediatric out-patient clinic of a university hospital, over a period of 5months from May to September 2013. Methods50 obese subjects of ages 2–16years and 50 healthy normal weight subjects of matched age and sex as controls were consecutively enrolled. Comprehensive history, anthropometric measurements and blood pressure were taken. BMI and degree of obesity were calculated. Fasting total serum magnesium, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured. ResultsObese cases compared to normal weight controls showed significantly lower serum magnesium and HDL-cholesterol levels and significantly higher total cholesterol, LDL-cholesterol, triglycerides, systolic and diastolic blood pressures. Serum magnesium showed a significant, strong inverse correlation with the degree of obesity (r=−0.8, p<0.001); significant, moderate inverse correlation with total cholesterol and LDL-cholesterol; and non-significant correlation with triglycerides and HDL-cholesterol. The degree of obesity showed a significant, moderate positive correlation with total cholesterol and LDL-cholesterol and a non-significant correlation with triglycerides and HDL-cholesterol. ConclusionSerum magnesium levels are inversely correlated with the degree of obesity, and is related to an unfavorable serum lipid profile in obese children and adolescents, who also show a trend to higher systemic blood pressure.

Serum Magnesium Status in Patients Subjects with Depression in the City of Yazd in Iran 2013-2014.

Depression is the most common mental disorder and involves many factors. The regulatory effects of magnesium on N-methyl-D-aspartate (NMDA) channels make it a factor in the treatment of depression. The present study investigated the level of serum magnesium in subjects diagnosed with depression in the city of Yazd in Iran. This cross-sectional study was done from January 2013 to January 2014 on 650 patients with depression who agreed to participate in this study. Diagnosis was made using the Beck Depression Inventory test (BDI-II); those scoring higher than 11 were sent to the medical school laboratory for further testing of serum magnesium levels. The mean age of the patients was 34.16 ± 9.12years. Of the 650 subjects, 195 were male (30%) and 455 were female (70%). The total mean serum magnesium was 2.1 ± 0.26mg/dl. The prevalence of hypomagnesemia 13.7%, hypermagnesemia 8.3%, and sub-optimal magnesium levels was 26.5%. Sub-optimal prevalence in women (28.1%) was higher than in men (26.2%). A significant relationship was observed between depression and serum magnesium level (p = 0.02). The results indicated that the prevalence of hypomagnesemia in subjects diagnosed with depression is high compared to non-depressed individuals. Moreover, there was a significant relationship between hypomagnesemia and intensity of depression that suggests a role for this element in the pathogenesis of the disorder. The high sub-optimal prevalence among women indicates that increased attention should be paid to this group.

Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana.

BackgroundMagnesium is the second most abundant intracellular cation and a co-factor in several reactions involved in the formation and usage of adenosine triphosphate and nucleic acid synthesis. Magnesium deficiency may be as high as 65 % in patients admitted to a medical Intensive Care Unit (ICU). Significant and potentially fatal conditions have been attributed to hypomagnesaemia and it has also been associated with poor prognosis and increased mortality in the critically ill. The study aimed to determine the prevalence and identify the predictive factors of preoperative hypomagnesaemia in adult surgical patients who require an emergency laparotomy.MethodsThis was a hospital based prospective study conducted at the Korle-Bu teaching hospital. General surgical patients between the ages of eighteen and seventy years with a preoperative diagnosis which required emergency laparotomy for management were consecutively enrolled into the study. A total of 102 patients were enrolled in the study. Preoperative total serum magnesium and serum potassium were determined.Data was summarised utilising simple descriptive statistics (i.e., proportions, ratios and percentages). The Chi-square test was used to determine significant differences or associations between categorical variables, Pearson’s correlation coefficient was used to determine the relationship between continuous variables and predictive factors were determined by multiple regression. Analysis was done in SPSS version 16.ResultsThe mean serum total magnesium and potassium were 0.66 ± 0.20 mmol/L and 3.79 ± 0.65 mmol/L respectively. The prevalence of preoperative hypomagnesaemia was found to be 68.0 %. Multiple logistic regression found only hypokalaemia to be a predictive factor (p-value of 0.001, odd’s ratio of 9.21 and a confidence interval of 2.42–35.09).ConclusionThe prevalence of preoperative hypomagnesaemia was high (68.0 %) with hypokalaemia the only predictive factor. Hypokalaemic patients requiring emergency laparotomy are nine times more likely to develop hypomagnesaemia as compared to patients who were not hypokalaemic.

Fluoride Modulates Parathyroid Hormone Secretion in vivo and in vitro

The study objective was to investigate the effects of fluoride on intact parathyroid hormone (iPTH) secretion. Thyro-parathyroid complexes (TPC) from C3H (n = 18) and B6 (n = 18) mice were cultured in Ca²⁺-optimized medium. TPC were treated with 0, 250, or 500 µ<smlcap>M</smlcap> NaF for 24 h and secreted iPTH assayed by ELISA. C3H (n = 78) and B6 (n = 78) mice were gavaged once with distilled or fluoride (0.001 mg [F^-]/g of body weight) water. At serial time points (0.5-96 h) serum iPTH, fluoride, total calcium, phosphorus, and magnesium levels were determined. Expression of genes involved in mineral regulation via the bone-parathyroid-kidney (BPK) axis, such as parathyroid hormone (Pth), calcium-sensing receptor (Casr), vitamin D receptor (Vdr), parathyroid hormone-like hormone (Pthlh), fibroblast growth factor 23 (Fgf23), α-Klotho (αKlotho), fibroblast growth factor receptor 1c (Fgf1rc), tumor necrosis factor 11 (Tnfs11), parathyroid hormone receptor 1 (Pth1r), solute carrier family 34 member 1 (Slc34a1), solute carrier 9 member 3 regulator 1 (Slc9a3r1), chloride channel 5 (Clcn5), and PDZ domain-containing 1 (Pdzk1), was determined in TPC, humeri, and kidneys at 24 h. An in vitro decrease in iPTH was seen in C3H and B6 TPC at 500 µ<smlcap>M</smlcap> (p < 0.001). In vivo levels of serum fluoride peaked at 0.5 h in both C3H (p = 0.002) and B6 (p = 0.01). In C3H, iPTH decreased at 24 h (p < 0.0001), returning to baseline at 48 h. In B6, iPTH increased at 12 h (p < 0.001), returning to baseline at 24 h. Serum total calcium, phosphorus, and magnesium levels did not change significantly. Pth, Casr,αKlotho,Fgf1rc,Vdr, and Pthlh were significantly upregulated in C3H TPC compared to B6. In conclusion, the effects of fluoride on TPC in vitro were equivalent between the 2 mouse strains. However, fluoride demonstrated an early strain-dependent effect on iPTH secretion in vivo. Both strains demonstrated differences in the expression of genes involved in the BPK axis, suggesting a possible role in the physiologic handling of fluoride.

Results from the Atherosclerosis Risk in Communities study suggest that low serum magnesium is associated with incident kidney disease

Low serum magnesium has been associated with kidney function decline in persons with diabetes as well as cardiovascular disease in the general population. Since the association of serum magnesium with incident kidney disease in the general population is unknown, we assessed this in 13,226 participants (aged 45 to 65) in the Atherosclerosis Risk in Communities study with baseline estimated glomerular filtration rate of at least 60 ml/min/1.73m2 in years 1987–89 and followed through 2010. The risks for incident chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with baseline total serum magnesium levels were evaluated using Cox regression. There were 1,965 CKD and 208 ESRD events during a median follow-up of 21 years. In adjusted analysis, low serum magnesium levels (0.7mmol/L or less) had significant associations with incident CKD and ESRD compared with the highest quartile with adjusted hazard ratio of 1.58 (95% CI: 1.35–1.87) for CKD and 2.39 (95% CI: 1.61–3.56) for ESRD. These associations remained significant after excluding users of diuretics and across subgroups stratified by hypertension, diabetes, and self-reported race. Thus, in a large sample of middle-aged adults, low total serum magnesium was independently associated with incident CKD and ESRD. Further studies are needed to determine whether modification of serum magnesium levels might alter subsequent incident kidney disease rates.

Retrospective evaluation of risk factors and outcome predictors in cats with diabetic ketoacidosis (1997-2007): 93 cases.

To determine risk factors and outcome predictors in cats with diabetic ketoacidosis (DKA). Retrospective study. Inclusion in the DKA group required blood glucose concentration > 13.9 mmol/L (250 mg/dL), venous pH < 7.35, and urine or serum acetoacetate concentration greater than 1.5 mmol/L (15 mg/dL). Signalment and weight were recorded in all cats with uncomplicated diabetes mellitus (DM) without DKA and in all other nondiabetic cats examined during the study period. Clinicopathologic variables, concurrent disorders, and initial insulin intravenous (IV) continuous-rate infusion (CRI) concentration of 1.1 or 2.2 U/kg/240 mL bag of 0.9% NaCl, were examined for a possible association with outcome. University teaching hospital. Ninety-three cats with DKA, 682 cats with uncomplicated DM, and 16,926 cats without DM or DKA. None. Cats with DKA were younger (median age 9.4 years; range, 1-17.9 years) than cats with uncomplicated DM (median 11.6 years; range 0.7-19.5 years, P < 0.0003). Siamese cats were overrepresented in the DKA group compared to the uncomplicated DM or nondiabetic group (P = 0.038 and P = 0.01, respectively). Poor outcome (defined as death due to disease or by euthanasia) in 36 cats with DKA (39%) was associated with increased initial creatinine, BUN, total serum magnesium, and total bilirubin concentrations (P = 0.007, P = 0.005, P = 0.03, P = 0.03, respectively). Cats treated with a higher concentration of insulin were less likely to have a poor outcome compared to cats treated with a lower concentration of insulin (odds ratio 0.14, 95% confidence interval 0.02-1.16, P = 0.02). Cats with DKA are more likely to be Siamese than cats with uncomplicated DM. Poor outcome of cats with DKA is associated with increased initial creatinine, BUN, total magnesium, and total bilirubin concentrations. Good outcome was associated with a higher concentration of IV insulin CRI.

Neonatal magnesium levels correlate with motor outcomes in premature infants: a long-term retrospective cohort study.

Objective: Chronic neurological deficits are a significant complication of preterm birth. Magnesium supplementation has been suggested to have neuroprotective function in the developing brain. Our objective was to determine whether higher neonatal serum magnesium levels were associated with better long-term neurodevelopmental outcomes in very-low birth weight infants.Study Design: A retrospective cohort of 75 preterm infants (<1500 g, gestational age <27 weeks) had follow-up for the outcomes of abnormal motor exam and for epilepsy. Average total serum magnesium level in the neonate during the period of prematurity was the main independent variable assessed, tested using a Wilcoxon rank-sum test.Results: Higher average serum magnesium level was associated with a statistically significant decreased risk for abnormal motor exam (p = 0.037). A lower risk for epilepsy in the group with higher magnesium level did not reach statistical significance (p = 0.06).Conclusion: This study demonstrates a correlation between higher neonatal magnesium levels and decreased risk for long-term abnormal motor exam. Larger studies are needed to evaluate the hypothesis that higher neonatal magnesium levels can improve long-term neurodevelopmental outcomes.

Micronutrient and physiologic parameters before and 6 months after RYGB

BackgroundBariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB). MethodsThirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed. ResultsThe mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021). ConclusionDespite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.

Pharmacokinetics and Pharmacodynamics of Subcutaneous Recombinant Parathyroid Hormone (1–84) in Patients With Hypoparathyroidism: An Open-Label, Single-Dose, Phase I Study

BackgroundImpaired mineral homeostasis affecting calcium, phosphate, and magnesium is a result of parathyroid hormone (PTH) deficiency in hypoparathyroidism. The current standard of treatment with active vitamin D and oral calcium does not control levels of these major minerals. Recombinant full-length human PTH 1–84 (rhPTH[1–84]) is being developed for the treatment of hypoparathyroidism. ObjectiveThe goal of this study was to investigate the pharmacokinetics and pharmacodynamics of a single subcutaneous injection of rhPTH(1–84) in patients with hypoparathyroidism. MethodsThis was an open-label, dose-escalating study of single subcutaneous administration of 50 µg and then 100 µg of rhPTH(1–84). Enrolled patients (age range, 25–85 years) had ≥12 months of diagnosed hypoparathyroidism defined according to biochemical evidence of hypocalcemia with concomitant low-serum intact PTH and were taking doses ≥1000 mg/d of oral calcium and ≥0.25 µg/d of active vitamin D (oral calcitriol). The patient’s prescribed dose of calcitriol was taken the day preceding but not on the day of or during the 24 hours after rhPTH(1–84) administration. Each patient received a single 50-µg rhPTH(1–84) dose, had at least a 7-day washout interval, and then received a single 100-µg rhPTH(1–84) dose. The following parameters were assessed: plasma PTH; serum and urine total calcium, magnesium, phosphate, and creatinine; and urine cyclic adenosine monophosphate. ResultsAfter administration of rhPTH(1–84) 50 µg (n = 6) and 100 µg (n = 7), the approximate t½ was 2.5 to 3 hours. Plasma PTH levels increased rapidly, then declined gradually back to predose levels at ~12 hours. The median AUC was similar with calcitriol and rhPTH(1–84) for serum 1,25-dihydroxyvitamin D (calcitriol, 123–227 pg · h/mL; rhPTH[1–84], 101–276 pg · h/mL), calcium (calcitriol, 3.3–3.7 mg · h/dL; rhPTH[1–84], 3.3–7.6 mg · h/dL), and magnesium (calcitriol, 0.7–0.9 mg · h/dL; rhPTH[1–84], 1.3–2.8 mg · h/dL). In contrast, the median AUC for phosphate was strongly negative with rhPTH(1–84) (calcitriol, −1.0 to 0.8 mg · h/dL; rhPTH[1–84], −21.3 to −26.5 mg · h/dL). Compared with calcitriol, rhPTH(1–84) 50 µg reduced 24-hour calcium excretion and calcium-to-creatinine ratios by 12% and 23%, respectively, and rhPTH(1–84) 100 µg reduced them by 26% and 27%. There was little overall impact on urine magnesium levels. Compared with calcitriol, rhPTH(1–84) 50 µg increased urinary phosphate excretion and phosphate-to-creatinine ratios by 53% and 54%, respectively, and rhPTH(1–84) 100 µg increased them by 45% and 42%. Urine cyclic adenosine monophosphate–to–creatinine ratio increased with rhPTH(1–84) by 2.3-fold (50 µg) and 4.4-fold (100 µg) compared with calcitriol. ConclusionsPTH replacement therapy with rhPTH(1–84) regulated mineral homeostasis of calcium, magnesium, phosphate, and vitamin D metabolism toward normal in these study patients with hypoparathyroidism.

EFFECT OF LACTATION STAGES ON SOME BLOOD SERUM BIOCHEMICAL PARAMETERS AND MILK COMPOSITION IN DAIRY COWS

This study was conducted using Forty five dairy cows selected randomly from small different farms. Blood and milk samples were collected during three stages of lactation (early, middle and late), on each serum sample total proteins, albumin, glucose, urea, total lipids, cholesterol, triglycerides, calcium, phosphorus and magnesium were determined. In each milk sample fat %, total proteins, calcium, phosphorous, and magnesium levels were measured. A significant effect of the lactation stages were observed on glucose, urea, total lipids, cholesterol, triglycerides, and calcium, while there were no significant differences during the three lactation stages on serum total protein, albumin, phosphorus and magnesium. In case of the examined milk samples there were no significant differences in fat %, urea, calcium, phosphorus and magnesium in the different lactation stages. While, there was a significant increase in milk protein in the middle and late lactation stages.

Serum Magnesium Level in Critically Ill Patients in a Tertiary Care Centre

Background: Hypomagnesemia is reported in up to 20% of patients in medical wards and 65% of patients in ICUs. A potential relationship between low magnesium levels and increased mortality has been suggested in the literature. Because magnesium depletion may not be accompanied by hypomagnesemia, the incidence of magnesium deficiency is even higher than indicated by the surveys of hypomagnesemia. Aims and Objectives: To study serum magnesium levels in critically ill patients and to correlate serum magnesium levels with patient outcome based on length of stay in ICU, need for and duration of ventilator support, APACHE score and mortality. Materials and Method: A prospective observational study was conducted in a tertiary care hospital from April 2011 to Nov 2011. It included 250 seriously ill patients, suffering from various medical conditions. Estimation of serum total magnesium levels was done on admission. Normal deviate (z) test and Chi-square test was applied for quantitative and qualitative data respectively to find significant associations between two variables. Results: Among 250 patients, 53.6% patients had hypomagnesemia, 43.6% had normal magnesium level and 2.8% had hypermagnesemia. The patients with hypomagnesemia had higher mortality rate (40%), more frequent need for ventilator support (62%), longer duration of mechanical ventilation (6.70±2.91) and higher incidence of sepsis (26.8%). The differences were statistically significant. Conclusions: Our study has found high prevalence of hypomagnesemia(53.6%) in critically ill patients. There were associations between hypomagnesemia and duration of ventilation, higher incidence of mortality and sepsis.

Maternal magnesium level effect on preterm labor treatment

Objective: To compare the initial serum magnesium levels between preterm labor (PL) and control groups and to evaluate MgSO4 treatment response in preterm labor group according to their initial serum magnesium levels.Methods: Hundred women diagnosed as preterm labor between 28 and 33 weeks of gestation and 100 non-complicated pregnant women were enrolled in this prospective study. Total basal serum magnesium levels were measured in both the groups. After a 6 g intravenous bolus of MgSO4, a dose of 2 g/h was given as an infusion in the preterm labor group.Results: Serum magnesium levels were significantly lower in preterm labor group (p < 0.001). The active contractions stopped in 69 (73,4%) preterm patients. The basal Mg level was significantly lower in this preterm group (1.6 versus 1.9, respectively, p < 0.001). Predictive value of basal magnesium level measurement for magnesium tocolysis response was calculated by receiver operating characteristic analyses with 95% confidence interval. Positive predictive and negative predictive values were found as 64.5% and 92.5%, respectively, with 83% accuracy, when cut-off magnesium value was taken as a <1.75 mg/dl (sensitivity = 80%, specificity = 84,1%).Conclusions: Basal magnesium levels in preterm labor had a predictive value in evaluating MgSO4 tocolysis response. It may help to select patients who are appropriate for MgSO4 tocolysis.

Targeted reduction in neurosurgical laboratory utilization: resident-led effort at a single academic institution

Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010-2011 fiscal year, yet were least likely to be abnormal or influence patient management. In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.