Low serum magnesium and 1‐year mortality in alcohol withdrawal syndrome

Abstract

Background:In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods:A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64%)and had not been prescribed magnesium (90%). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age (P < 0.05), GMAWS (P < 0.05), BDZ (P < 0.05), bilirubin (P < 0.001), alkaline phosphatase (P < 0.001), albumin (P < 0.001), CRP (P < 0.05), AST:ALT ratio >2 (P < 0.001), sodium (P < 0.05), magnesium (P < 0.001), platelets (P < 0.05) and the use of proton pump inhibitor medication (P < 0.001) were associated with death at 1 year. On multivariate binary logistic regression analysis, age > 50 years (OR 3.37, 95% CI 1.52-7.48, P < 0.01), AST:ALT ratio >2 (OR 3.10, 95% CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95% CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001).

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

“…4). These results are consistent with a recent retrospective study (n = 380) that reported a prevalence of low serum magnesium concentrations (< 0.75 mmol/L) (> 60%) and 17% 1-year mortality for patients presenting with AWS [9].…”

“…Alcohol exerts direct and indirect effects on cellular energy metabolism and alcohol use disorder (AUD) is a complex psychological and pathophysiological problem [7, 8]. Nutritional and social factors may be protective or contributory, however a threshold may be reached beyond which alcohol related compromise of oxidative resilience manifests in accelerated organ/system specific final common pathways of biochemical and clinical deterioration [7, 9]. The occurrence of alcohol withdrawal syndrome (AWS) may represent the crossing of that threshold [9].…”

“…We recently reported in a retrospective study that patients who experienced an episode of alcohol withdrawal syndrome received thiamine supplementation although thiamine diphosphate (TDP) concentrations were not determined. In contrast, serum magnesium concentrations were measured and patients who had low serum magnesium concentrations (Mg 2+ < 0.75 mmol/L) were rarely supplemented and were four times more likely to die at 1 year [9]. Furthermore, there was little supplementation of such low magnesium concentrations following discharge from hospital.…”

Magnesium Metabolism in Chronic Alcohol-Use Disorder: Meta-Analysis and Systematic Review

“…We urge that patients with chronic alcohol-use disorder have frequently blood magnesium measured. This suggestion is supported by recent data that implicate magnesium depletion in high mortality in this condition [45,46].…”

An overview of diagnosis and management of drug‐induced hypomagnesemia

“… 150 In a study of 380 patients presenting with alcohol withdrawal syndrome, Mg deficiency (<0.75 mmol/L; 1.8 mg/dl) was associated with significant higher 1‐year mortality rate. 151 It has been proposed that ionized Mg concentration in erythrocytes and plasma is more reliable than total Mg in the assessment of Mg homeostasis in alcoholic patients. 152 Decreased Mg intake in malnourished patients, increased gastrointestinal Mg losses in patients suffering from chronic diarrhea, as well as increased Mg entry into cells due to both respiratory alkalosis and excessive catecholamine release in alcohol withdrawal syndrome comprise the major pathogenetic mechanisms.…”