Hypomagnesemia in critically ill patients

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importance of Magnesium levels on the critically ill patients and in ICU

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Hypomagnesemia in critically ill patients

  1. 1. HYPOMAGNESEMIA IN CRITICALLY ILL MEDICAL PATIENTS CS Limaye, VA Londhey, MY Nadkar, NE Borges FROM JAPI JAN 2011 MODERATORDR. AJEET KR. CHAURASIYA PRESENTED BY VINEET MISHRA
  2. 2. Magnesium  50% to 60% contained in bone  4TH most common cation in the body  Coenzyme in metabolism of protein and carbohydrates  Factors that regulate calcium balance appear to influence magnesium balance  Acts directly on myoneural junction  Important for normal cardiac function
  3. 3. Low serum Mg caused by  Prolonged fasting or starvation  Shift: Pancreatitis, Insulin administration , Post- parathyroidectomy  Chronic alcoholism  Fluid loss from gastrointestinal tract  Prolonged parenteral nutrition without supplementation  Diuretics, aminoglycosides, cisplatinum, amphotericin
  4. 4. Manifestations  Tremors, tetany , ↑ reflexes, paresthesias of feet and legs, convulsions  Positive Babinski , Chvostek and Trousseau signs  Personality changes with agitation, depression or confusion, hallucinations  ECG changes (tall peaked , flat or inverted T waves ; ST depression , U waves, voltage loss , wide QRS and prolonged PR)
  5. 5. SIGNS EXCESS DEFICIENCY Magnesium (Mg) Hypermagnesaemia Loss of deep tendon reflexes (DTRs) Depression of CNS Depression of neuromuscular function Hypomagnesaemia Hyperactive DTRs CNS changes
  6. 6. BACKGROUND  Hypomagnesaemia is an important but underdiagnosed electrolyte abnormality in critically ill patients.  There are many studies to find the prevalence of hypomagnesaemia and its effects on mortality and morbidity in these patients  Studies have been carried out in intensive care units.   in respiratory intensive care unit critically ill cancer patient
  7. 7. AIMS AND OBJECTIVES • To study serum magnesium levels in critically ill patients • To correlate serum magnesium levels with patient outcome. • To identify the primary medical conditions associated with abnormalities of serum magnesium • To identify the factors predisposing or contributing to hypomagnesaemia in critically ill patients admitted in a medical intensive care unit • To detect other electrolyte abnormalities associated with hypomagnesemia
  8. 8. PARAMETERS  Length of stay in MICU  Need for ventilatory support  Duration of ventilatory support  APACHE score  Mortality
  9. 9. METHODOLOGY  Prospective observational study was carried out in the Medical Intensive Care Unit(from April 2004 to May 2005)  Hundred patients admitted to the MICU for critical illnesses were INCLUDED in the study  Patients who had received magnesium prior to transfer to MICU were EXCLUDED  Blood sample was collected for estimation of serum total magnesium levels
  10. 10.  History and clinical findings were noted  Hematological, biochemical and radiological investigations were performed  APACHE score was calculated for each patient on the day of admission  Serum total magnesium level (1.7 to 2.4 mg/dl) was determined by colorimetric method using Titan yellow  Normal deviate (z) test was applied for quantitative data and chi-square test was applied for qualitative data
  11. 11. CRITICAL DISEASES • Severe infections like  complicated malaria,leptospirosis, tetanus, urinary tract infections, cellulitis, meningitis, pneumonia, tuberculosis and mucormycosis. • Hepatic failure • Acute renal failure • Chronic renal failure • Respiratory failure
  12. 12.  Congestive cardiac failure  Cerebrovascular accident  Poisonings including Organophosphate compounds  Snake bite  Acute pancreatitis  Guillain-Barre syndrome  Malignancy  Status epilepticus and  Diabetic ketoacidosis
  13. 13. Study result Alcoholism DM Sepsis Hypokalemia Hypoalbuminemia Normo Hypocalcemia Hypo APACHE MICU stay Ventilator days Ventilator need Mortality 0 20 40 60 80 Representational values 100
  14. 14. CONCLUSION HYPOMAGNESEMIA AFFECTED/ASSOCIATED WITHHYPOCALCEMIA HYPOALBUMINEMIA VENTILATOR NEED ON VENTILATOR DURATION SEPSIS DIABETES MELLITUS MORTALITY
  15. 15. CONCLUSION CONTD. . . . . HYPOMAGNESEMIA NOT AFFECTED/ASSOCIATED WITHMICU STAY APACHE II SCORE HYPOKALEMIA ALCOHOLISM (CHRONIC)
  16. 16. SUMMARY  Hypomagnesaemia is a common electrolyte imbalance in the critically ill patients.  Whether hypomagnesaemia directly contributes to cellular alterations leading to increased mortality, morbidity and poor patient outcome in critically ill patients or it is just a marker of critical illness is not clear.  Hypomagnesaemia is associated with higher mortality rate in critically ill patients and is also associated with more frequent and more prolonged ventilatory support.
  17. 17.  It was seen in this study that hypomagnesaemia is frequently associated with sepsis and diabetes mellitus.  Although there was a high incidence of hypomagnesaemia in the present study, its correction after magnesium supplementation was not included as a part of the study.  The potential benefit of magnesium supplementation to prevent or correct hypomagnesaemia in critically ill patients requires further study.
  18. 18. MAGNESIUM ESTIMATION  Specimen: non-hemolyzed serum or lithium heparin      plasma used. EDTA and citrate bind to the Mg. 24hr urine may be used and should be acidified to avoid Ppt. Colorimetric method/photometric[TITAN YELLOW]: Mg binds to calmagite, formazen dye and methylthymol blue to form a chromogen that is measure at 532- 600nm. Ca2+ should be eliminated from the sample AAS- absorbance at 285.2nm ISE- free Mg with neutral carrier inonophores
  19. 19. TAKE HOME MESSAGE Hypomagnesaemia is NOT A RARE electrolyte abnormality in critically ill patients. Hypomagnesemia should NOT be misdiagnosed as Hypokalemia. It should be ordered with Na, K and Ca serum levels. REMEMBER HYPOMAGNESEMIA TOO !!

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