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

Authors

  • Siddappa F. Dandinavar Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
  • Suma D. Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
  • Vinod H. Ratageri Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
  • Prakash K. Wari Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20190228

Keywords:

Children, Hypomagnesemia, Intensive care unit, Mortality, Outcome, PICU

Abstract

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.

References

Elin RJ. Magnesium: the fifth but forgotten electrolyte. Am J Clini Pathol. 1994;102(5):616-22.

Ebel H, Günther T. Magnesium metabolism: a review. Clini Chem Lab Med. 1980;18(5):257-70.

Singhi SC, Singh J, Prasad R. Hypo‐and Hypermagnesemia in an Indian Pediatric Intensive Care Unit. J Tropical Pediat. 2003;49(2):99-103.

Saleem AF, Haque A. On admission hypomagnesemia in critically ill children: Risk factors and outcome. Ind J Pediat. 2009;76(12):1227-30.

Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in critically ill sepsis patients. J Clini Med Res. 2015;7(12):911.

Zafar MS, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill-patients. Int J App Basic Medical Res. 2014;4(1):34.

Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India. 2011;59(1):19-22.

Safavi M, Honarmand A. Admission hypomagnesemia--impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol. 2007;19(3):645-60.

Chen M, Sun R, Hu B. The influence of serum magnesium level on the prognosis of critically ill patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015;27(3):213-7.

Broner CW, Stidham GL, Westenkirchner DF, Tolley EA. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients. Critical Care Med. 1990;18(9):921-8.

Noronha LJ, Matuschak GM. Magnesium in critical illness: metabolism, assessment, and treatment. Intensive Care Med. 2002;28(6):667-79.

Guerin C, Cousin C, Mignot F, Manchon M, Fournier G. Serum and erythrocyte magnesium in critically ill patients. Intensive Care Med. 1996;22(8):724-7.

Deshmukh C T, Rane S A, Gurav M N. Hypomagnesaemia in paediatric population in an intensive care unit. J Postgrad Med. 2000;46(3):179.

Singla PN, Chand P, Kumar A, Kachhawaha JS. Serum magnesium levels in protein-energy malnutrition. Journal Tropical Pediat. 1998;44(2):117-9.

Kumar S, Honmode A, Jain S, Bhagat V. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India. Indian J Crit Care Med: Indian Society of Critical Care Med. 2015;19(7):379.

Swaminathan R. Magnesium metabolism and its disorders. Clinic Biochem Reviews. 2003;24(2):47-66.

Soliman HM, Mercan D, Lobo SS, Mélot C, Vincent JL. Development of ionized hypomagnesemia is associated with higher mortality rates. Critical Care Med. 2003;31(4):1082-7.

Escuela MP, Guerra M, Añón JM, Martínez-Vizcaíno V, Zapatero MD, García-Jalón A, Celaya S. Total and ionized serum magnesium in critically ill patients. Intensive care medicine. 2005;31(1):151-6.

Huijgen HJ, Soesan M, Sanders R, Mairuhu WM, Kesecioglu J, Sanders GT. Magnesium levels in critically ill patients. What should we measure? Am J Clin Pathol. 2000;114(5):688-95.

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Published

2019-02-23

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Original Research Articles