Hypomagnesemia after spinal fusion

Abstract

Objectives: To determine the frequency of hypomagnesaemia in pediatric patients after spinal fusion, to verify whether postoperative magnesium levels were lower than preoperative levels and, if so, to identify possible causes and assess the clinical repercussions for patients. Methods:This was a retrospective descriptive study of pediatric patients admitted to a pediatric intensive care unit (ICU) after spine fusion surgery, between March 1 and August 31, 2011. Preoperative magnesium, phosphorus and total and ionized calcium concentrations were compared with the results of tests conducted during the first 24 hours after admission to the ICU. Results:A total of 45 patients were enrolled on the study. Median age was 13.1 years. Preoperative mean serum magnesium was 1.8±0.2 mg/dL and postoperative serum magnesium was 1.4±0.2 mg/dL, which was a significant reduction between the two periods (p < 0.001). The frequency of hypomagnesaemia rose from 1 patient (2%) in the preoperative period to 31 patients (68%) during the postoperative period. There were also significant reductions in concentrations of phosphorus (p < 0.001) and total calcium (p < 0.001). There was a significant correlation between magnesium reductions and the volume of fluids administered during the surgery (p = 0.03), transfused blood volume (p < 0.001) and number of vertebrae fused (p < 0.05). Seven of the 31 patients with hypomagnesemia exhibited symptoms (22%). Conclusion:There was an elevated frequency of hypomagnesemia in patients who underwent spinal fusion. Serum magnesium should be assayed when patients are admitted to the pediatric ICU, so appropriate supplementation can be initiated immediately, minimizing the risk of complications.J Pediatr (Rio J). 2012;88(3):227-32: Hypomagnesemia, pediatric ICU, spine fusion. ResumoObjetivos: Verificar a frequência de hipomagnesemia em pacientes pediátricos submetidos a artrodese de coluna, avaliando se há queda significativa nas dosagens de magnésio sérico nos períodos pré e pós-operatório, quais suas possíveis causas e quais as consequências clínicas para os pacientes. Métodos:Estudo retrospectivo e descritivo dos pacientes admitidos em uma Unidade de Terapia Intensiva pediátrica no pós-operatório de artrodese de coluna, no período de 1º de março a 31 de agosto de 2011. Foram comparados os níveis de magnésio, fósforo, cálcio total e ionizado no pré-operatório com os valores encontrados após a admissão na Unidade de Terapia Intensiva. Resultados:Foram incluídos 45 pacientes, com idade média de 13,1 anos. No pré-operatório, o valor médio do magnésio foi de 1,8±0,2 mg/dL, e no pós-operatório, de 1,4±0,2 mg/dL, o que demonstra uma queda significativa entre os dois períodos (p < 0,001). A frequência de hipomagnesemia foi de somente um paciente (2%) no pré-operatório para 31 (68%) no pós-operatório. Houve também queda significativa nos níveis de fósforo (p < 0,001) e cálcio total (p < 0,001). Houve correlação significativa entre a queda do magnésio e o volume de fluido recebido durante a cirurgia (p =...

An assessment of changes in the magnesium level during gynecological abdominal surgeries

“…They may also consider monitoring or correcting changes routinely to prevention morbidities in high-risk patients. Finally, we could say that the impact of postoperative hypomagnesemia and its impression on postoperative outcome [13][14][15][16][17][18] such a slow cardiac response, less pain control, inadequate muscle tone, and shortage in well-being need larger-scale trails. May be with timely diagnosis, we can prevent bad outcomes or morbidities in our centre and bring more satisfaction for patients, less hospitalization, and costs.…”

“…Many of those are well known and measured routinely. [3,[12][13][14][15][16][17][18][19] For example, postoperative serum potassium or hematocrit levels were assessed routinely for replacement or transfusion. Other parameters like serum albumin or total calcium level reflect the magnitude of fluid and electrolyte imbalances caused by the operative procedures and its anesthesiologic resuscitation.…”

“…Studies have not examined the magnitude of alteration in postoperative Mg level in gynecological abdominal surgeries or its impact on postoperative outcome in females only. [3,[12][13][14][15][16][17][18]20] Postoperative hypomagnesemia has been reported in other types of operation like major cancer series, cardiac, colorectal surgeries, thyroidectomies, and spinal fusion. [13][14][15][16][17][18]20,21] Recompense of lowered serum Mg perioperatively has some benefits.…”

“…[3,[12][13][14][15][16][17][18]20] Postoperative hypomagnesemia has been reported in other types of operation like major cancer series, cardiac, colorectal surgeries, thyroidectomies, and spinal fusion. [13][14][15][16][17][18]20,21] Recompense of lowered serum Mg perioperatively has some benefits. For example, reduction in cardiac dysrhythmias, primary atrial tachyarrhythmias, [11,[13][14][15]22] reduced anesthetic need when given as an adjunct to general anesthesia, inhibition of platelet dependent thrombosis, attenuate adverse cardiovascular effects during laryngoscopy, and intubation.…”

“…It probably depends on serum loss and IV fluid replacement, perioperative bowel preparation with sodium phosphate purgatives, [2,[13][14][15] citrate administration, and prior therapy with beta-blockers that have been presented by other authors. [7,[13][14][15][16][17][18] However, these factors did not seem to play an important role in our patients, because we excluded all those risk factors before the study. Other causes of hypomagnesemia related to total albumin and protein reduction.…”