ARTICLE INFO

Article Type

Original Research

Authors

Peivandi Yazdi   A. (1)
Hashemi   I. (2)
Salehi   M. (3)
Masoumzadeh   M. (1)
Razavi   M. (* )






(* ) “Cardiac Anesthesia Research Center, Imam Reza Hospital” & “Anesthesiology Department, Medicine Faculty”, Mashhad University of Medical Sciences, Mashhad, Iran
(1) “Cardiac Anesthesia Research Center, Imam Reza Hospital” & “Anesthesiology Department, Medicine Faculty” , Mashhad University of Medical Sciences, Mashhad, Iran
(2) Clinical Biochemistry Department, Medicine Faculty , Mashhad University of Medical Sciences, Mashhad, Iran
(3) Social Medicine Department, Medicine Faculty, Mashhad University of Medical Sciences, Mashhad, Iran

Correspondence

Address: 2nd Floor, No. 37, East Golestan 6th Street, Golestan Street, Mashhad, Iran. Postal Code: 9697114155
Phone: +985118525209
Fax: +985118525209
razavim@mums.ac.ir

Article History

Received:  December  13, 2013
Accepted:  March 11, 2014
ePublished:  February 1, 2014

BRIEF TEXT


Since magnesium is necessary for proper functioning of membranous pumps, magnesium depletion results in depolarization of cardiac cells and tachy-arrhythmias [1-3]. There are three ways to measure magnesium. Magnesium infusion test (loading test) is one of the ways to measure intracellular magnesium. After acute infusion of elemental magnesium (2.4 mg per kg body weight), 24-hour urine is collected. Magnesium secretion in the urine less than 80% of the loaded is considered an indicator for magnesium deficiency in the whole body [5-10].

There are some conducted researches about magnesium and hypomagnesemia, concerning hypomagnesemia probability and magnesium change after some surgeries and their relations to patients’ mortality [4, 12-14, 16, 17].

The aims of the study were to investigate the prevalence of hypomagnesemia in patients undergoing elective surgery in the first 24 hours of hospitalization, and to compare severity of illness (based on SAPS criterion) and magnesium plasma level with the actual total body magnesium deficiency.

Research type is intervening cross-sectional.

Research society was the population of patients who had undergone elective abdominal surgery with general anesthesia, and had been admitted to the ICU. The research was conducted during December 2012, at surgical ICU of Imam Reza hospital, Mashhad, Iran.

60 patients were selected, using easy non-probable sampling method for study. Research entry criteria were as the followings: Written consent from the patient family to enter the study (with exit permission from the study at any time the patient wish); receiving proper calorie at 7 to 10 days leading up to the study; no decrease in body weight more than 10% of total body weight at one month leading up to the study; without cirrhosis, diarrhea, the use of diuretic, aminoglycosides, and non-steroidal anti-inflammatory drugs, at one month leading up to the study; without any impaired renal or adrenal, known syndromes barring magnesium administration (such as long QT syndrome); and no need for cardiopulmonary resuscitation during first day of admission. SAPA criterion was used to assess similarity of disease severity and prediction of its outcome at the entry to ICU. To determine expected mortality in this criterion, 12 physiologic and demographic variables were used. Photometry method [11] was applied in order to take needed plasma samples (to determine SAPS) and in order to perform routine tests, as well as to measure total magnesium of plasma; and magnesium excretion in the urine less than 80% of prescribed magnesium was considered total deficiency of body magnesium. Age, gender, height, weight, body mass index (BMI), SAPS number, the probability of mortality based on SAPS, sodium, total magnesium, calcium, potassium and plasma phosphorus levels within 24 hours of hospitalization and the total urinary excretion of magnesium in the first 24-hour of hospitalization at ICU was measured and recorded. Plasma magnesium less than 1.7 mg per deciliter and more than 2.6 mg per deciliter was considered hypomagnesemia and hypermagnesemia, respectively; and plasma magnesium less than 1 mg per deciliter was considered intense hypomagnesemia.

Data were analyzed through Independent T test (in order to compare SAPS criterion, age, height, weight, body mass index, sodium, potassium, calcium, magnesium, and phosphorus serum level, in “total magnesium deficiency” and “without total magnesium deficiency” two groups) and Chi Square test (in order to compare sex effectiveness in these two groups), using SPSS 16 software.

Average age of the samples was 61.03±17.03 years. 35 persons (58.3%) were male. Average height of the samples was 166.97±8.95 cm. Average weight was 67.75±13.18kg. Average BMI was 24.27±4.27kg per square meter. Average admission length in ICU for the patients was 53.18±9.97hours. Average computed SAPS score for the patients on arrival at the ICU was 31.88±8.96, and on this basis the expected average mortality was 15.87±10.21% according to the criterion. Average total magnesium in urine during first 24 hours of hospitalization was 2.06±1.31mMol, and average non-excreted magnesium in urine (body total magnesium deficiency) after magnesium dose loading was 1.97±0.6mMol. On admission to ICU, 28 patients (46.7%) had magnesium deficiency. On arrival at ICU, magnesium, sodium, potassium, calcium, and phosphorus serum level of the patients were 0.78±0.16mg per deciliter, 140.22±2.22mg per deciliter, 4.05±0.53mg per deciliter, 8.23±1.06mg per deciliter, and 4.30±0.59mg per deciliter, respectively. Magnesium, sodium, potassium, calcium, and phosphorus serum level, and demographic characteristics (age, sex, weight, height, and BMI) indicated no significant relation to body total magnesium after magnesium dose loading. In addition, there was no significant relation between body total magnesium after magnesium dose loading and length of hospitalization at ICU. Nevertheless, there was a significant difference in total magnesium deficiency of body after magnesium dose loading with expected mortality rate of patients using SAPS criterion; and the more the SAPS, followed by higher mortality rate, the more the magnesium deficiency chance and its severity at the beginning of hospitalization at ICU was.

According to a study, hypomagnesemia frequency among children undergoing spinal fusion surgery is 22% [1], which is less than the results of the present study, conducted among adults. Another study indicates magnesium amount of hospitalized patients at ICU more than that of normal situation [15], which is inconsistent with the results of the present study. Based on the results of a study, it is believed that hypomagnesemia monitoring during hospitalization at ICU can acts as a predictor factor to determine patients’ mortality rate [2], which is consistent with the result of the present study.

Non-declared

Non-declared

Magnesium Serum level is an unreliable indicator of hypomagnesemia. The greater the total magnesium deficiency of the body, the worse the prognosis is.

Researchers feel grateful to Research Deputy of Mashhad University of Medical Sciences and nurses of ICU at Imam Reza hospital.

Non-declared

Ethic Committee of Mashhad University of Medical Sciences confirmed the study. Sampling was done by consent.

The paper is based on a residency thesis. Research Deputy of Mashhad University of Medical Sciences funded the research.


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