Hypomagnesemia in Critically Ill Sepsis Patients

Velissaris, Dimitrios; Karamouzos, Vasileios; Pierrakos, Charalampos; Αρέθα, Διαμάντω; Καρανικόλας, Μενέλαος

doi:10.14740/jocmr2351w

Cited by 77 publications

(60 citation statements)

References 39 publications

(50 reference statements)

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“…largely from observational studies, that hypomagnesemia is significantly associated with increased need for mechanical ventilation, prolonged ICU stay and increased mortality. 5 Critically ill patients are predisposed to both symptomatic and asymptomatic magnesium deficiency that can lead to some important clinical consequences such as hypokalemia, cardiac arrhythmias, hypocalcemia, neurotoxicity and psychiatric problems, leading to increased morbidity and mortality. 6 The available data on altered Mg levels in pediatric intensive care unit (PICU) setting is scarce, especially from developing countries.…”

mentioning

confidence: 99%

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Dandinavar

Suma

Ratageri

et al. 2019

Int J Contemp Pediatr

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Background: Magnesium deficiency is common in critical illness and is said to be associated with increased need for mechanical ventilation, mortality and prolonged ICU stay. The knowledge of hypomagnesemia is essential as available data is scarce and it could have prognostic and therapeutic implications. This study was undertaken to estimate the prevalence of hypomagnesemia at the time of admission in PICU and its correlation with length of PICU stay, duration on mechanical ventilator and outcome at the end of hospital stay-death or discharge.Methods: This is a prospective observational study including 343 children aged 1month to 12years admitted to PICU. Detailed history taking and clinical examination was done for all enrolled children. At admission, blood was collected for estimation of serum magnesium. Patients were categorized into three groups i.e., hypomagnesemia, normomagnesemia and hypermagnesemia and data was analysed.Results: Out of 343 children, 28% had hypomagnesemia, 7.3% had hypermagnesemia and 64.7% had normomagnesemia. Hypomagnesemia was more common in neurological disorders. No association was found between magnesium and length of mechanical ventilation. PICU stay was significantly longer in hypomagnesemia group (p=0.031). 37.5% patients with hypomagnesemia also had hypocalcemia and 35.4% had hypokalemia. Mortality rate was higher in those with hypomagnesemia (30.2%) compared to those with normomagnesemia (22.1%).Conclusions: Patients with hypomagnesemia had increased duration of PICU stay, other associated electrolyte abnormalities and higher mortality. Hence monitoring of magnesium levels in critically ill patients is indicated.

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mentioning

confidence: 99%

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Dandinavar

Suma

Ratageri

et al. 2019

Int J Contemp Pediatr

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“…Previous reviews conducted during 2008‐2015 have emphasised a lack of intervention trials . Despite the associations shown in observational studies, it is uncertain whether evidence of harms or beneficial effects of supplementation therapy exists from randomised clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Effects of magnesium, phosphate and zinc supplementation in ICU patients—Protocol for a systematic review

Vesterlund

Thomsen²,

Møller

et al. 2019

Acta Anaesthesiol Scand

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Background: Depletion of the trace elements magnesium, phosphate and zinc is common in patients admitted to the intensive care unit (ICU). Observational studies have suggested worse outcome in patients with hypomagnesaemia, hypophosphataemia or hypozincaemia, but also inverse associations with worse outcome with too high serum levels. However, it is unclear whether data from randomised clinical trials (RCTs) confirm this. Accordingly, we plan to assess the balance between benefits and harms of supplementation as compared with placebo or no supplementation in adult ICU patients. Methods:We will conduct a systematic review of RCTs with meta-analysis and trial sequential analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. We will assess the effects of any supplementation with magnesium, phosphate or zinc vs. placebo or no treatment in adult ICU patients. We will systematically search the Cochrane CENTRAL, Embase, PubMed, and for unpublished trials: ClinicalTrials.gov, the EU clinical TrialsRegister and the WHO International Clinical Trials Registry Platform. The primary outcomes will be days alive without mechanical ventilation and overall mortality.Secondary outcomes include use for mechanical ventilation, tachy-arrhythmias, use of vasopressors, length of hospital stay and use of renal replacement therapy. Discussion:The benefits and harms of supplementation therapy with magnesium, phosphate and zinc in general ICU patients are unknown. This outlined systematic review will provide data on the evidence, on which future recommendations for supplementation may be founded.

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“…Hypomagnesaemia is common in septic patients and is associated with poor outcomes [62]. Both supra-and ventricular arrhythmias are one of the various manifestations of hypomagnesaemia.…”

Section: Electrolyte Disturbances In Sepsismentioning

confidence: 99%

Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

Anaesthesiol Intensive Ther

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The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.

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Hypomagnesemia in Critically Ill Sepsis Patients

Cited by 77 publications

References 39 publications

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Effects of magnesium, phosphate and zinc supplementation in ICU patients—Protocol for a systematic review

Management of arrhythmia in sepsis and septic shock

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