Magnesium in Intensive Care Unit : A Review

Abstract

Aim of the work: there is an increased interest in the role of magnesium ions in clinical medicine, nutrition and physiology. Magnesium affects many cellular functions, including transport of potassium and calcium ions and modulates signal transduction, energy metabolism and cell proliferation. Magnesium deficiency is not uncommon among the general population: its intake has decreased over the years. Magnesium derangement results in various symptoms and signs; magnesium supplementation or intravenous infusion may be beneficial in various diseased states; so this review aimed to highlight the physiology of magnesium in humans, the derangement of magnesium in the form of hyper and hypomagnesemia , their clinical picture and the clinical and therapeutic uses of magnesium in the critical ill patients. Methods: references were obtained from Medline, Google Scholar and Ovid from 1960 to 2017. All categories of articles (clinical trials, reviews, or metaanalyses) on this topic were selected. Conclusion: magnesium is a critical physiological ion; it has many known indications in anesthesiology and intensive care because of its interactions with drugs used in intensive care. Intensive care specialists need to have a clear understanding of the role of this important cation. Magnesium is gaining recognition as a clinically important electrolyte in intensive care and emergency medicine .Recent clinical trials and case reports increase interest of magnesium as an effective therapeutic agent for potentially life-threatening problems such as torsade de pointes, digitalis toxicity, bronchospasm and alcohol withdrawal, subarachnoid hemorrhage, acute myocardial infarction, preecalmsia , eclamsia ,hypertension , diabetes , metabolic syndrome and cardiac arrhthymias .

Management of asthma exacerbation in the emergency departments

“…Magnesium is an important cofactor in numerous enzymatic reactions, including the inhibition of calcium uptake in smooth muscles to cause muscle relaxation [55,56]. Magnesium may also inhibit cholinergic transmission, stimulate nitric oxide and prostacyclin synthesis, and stabilize mast cells and T-lymphocytes [57]. Meta-analyses and systematic reviews have demonstrated the effect of intravenous magnesium.…”

Effect of magnesium sulfate treatment on mediators of endothelial dysfunction and electrolytes in mild and severe preeclampsia: A case‐control study

“…There are concerns regarding the possibility of hypermagnesemia toxicity in eclampsia treatment, among other complications. 13 …”

“…It remains unclear the effect of MgSO 4 therapy on the levels of ED mediators (adrenomedull [AM], calcitonin gene‐related peptide [CGRP], and soluble forms of intercellular adhesion molecule‐1 [sICAM‐1]), and electrolytes [Na, K, and Mg]). There are concerns regarding the possibility of hypermagnesemia toxicity in eclampsia treatment, among other complications 13 …”

“…There are concerns regarding the possibility of hypermagnesemia toxicity in eclampsia treatment, among other complications. 13 Moreover, study shows complications of pregnancy arise as a result of several pathophysiologic conditions including ED and electrolyte imbalance. 14 Mediators of ED and electrolytes are known to play crucial roles in the development of PE; however, the levels and physiological changes that trigger symptoms have not been elucidated.…”

Magnesium Sulphate (MgSO4) Nebulization versus Salbutamol Nebulization in Acute Asthmatic Attacks in Adults

“…Also, magnesium inhibits acetylcholine release, depressing muscle fiber excitability. Moreover, magnesium is thought to reduce asthma severity by stimulating synthesis of nitric oxide and prostacyclin [6,7] . Lastly, magnesium increases the bronchodilator effect of β2 adrenergic agonists through β2 receptors upregulation, and through the increase of the agonists affinity to their receptors [8,9] .…”