DOI: http://dx.doi.org/10.18203/2349-3933.ijam20195663

Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

Akshay R. Khare, Vishwanath C. Patil, Jignesh N. Shah, Shivakumar S. Iyer

Abstract


Background: Admission hypomagnesemia has been linked with an increased risk of septic shock. The purpose of this study was to evaluate admission serum magnesium levels in patients with septic shock and to determine its correlation with the outcomes.

Methods: It was a prospective observational study. Total 50 patients fitting the Sepsis-3 definition between time period of June 2017 to November 2018 were included in the study. Patients with suspected infection were identified at the bedside with qSOFA. Admission serum magnesium levels was measured for all patients included. APACHE II scores were calculated at the end of 24 hours after admission. Routine standard of care treatment was provided to all patients. The patients were monitored for organ dysfunctions based on daily SOFA scores, ventilator free days, vasopressors free days, dialysis free days, length of intensive care unit stay, length of hospital stay. The data was analysed using Statistical Package for Social Sciences for MS Windows.

Results: In this study hypomagnesemia was prevalent in 18%, normomagnesemia in 62% and hypermagnesemia in 20% of total included patients. The mean vasopressor free days in Hypomagnesemia group (7.11±12.79 days) were higher than those in normomagnesemic patients (5.06±5.51 days) and hypermagnesemia patients (1.70±3.09 days). Out of total 50 patients 18 died and 32 recovered. 11 patients out of 32 who recovered had abnormal admission serum magnesium levels whereas 8 pts out of 18 who died had abnormal admission serum magnesium levels.  SOFA score in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients was statistically significant.

Conclusions: Author did not find any statistically significant correlation between admission magnesium levels in septic shock patients and outcomes although SOFA score was higher in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients. Serum magnesium may not truly reflect body’s magnesium status. RBC magnesium may need to be studied to see whether it is a more reliable biomarker.

Keywords


Hypomagnesemia, Septic shock, Sequential organ failure assessment

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References


Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest. 2017;151(6):1229-38.

Thongprayoon C, Cheungpasitporn W, Erickson SB. Admission hypomagnesemia linked to septic shock in patients with systemic inflammatory response syndrome. Renal Failure. 2015;37(9):1518-21.

Al Alawi AM, Majoni SW, Falhammar H. Magnesium and human health: perspectives and research directions. Int J Endocrinol. 2018.

Topf JM, Murray PT. Hypomagnesemia and hypermagnesemia. Rev Endocrine Metab Dis. 2003;4(2):195-206.

Pranskunas A, Vellinga NA, Pilvinis V, Koopmans M, Boerma EC. Microcirculatory changes during open label magnesium sulphate infusion in patients with severe sepsis and septic shock. BMC Anesthesiol. 2011;11(1):12.

Rubeiz GJ, Thill-Baharozian MA, Hardie DO, Carlson RW. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med. 1993;21(2):203-9.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Med. 1985;13(10):818-29.

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

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Int Care Med. 1996 July;22(7):707-10.

Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-74.

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.

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

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

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

Gupta SS, Bindra GS, Batada V, Gupta AK. To study serum magnesium level and its correlation with prognostic significance in critically ill patients. J Ind Acad Clin Med. 2016;17(1):37.

Celi LA, Scott DJ, Lee J, Nelson R, Alper SL, Mukamal KJ, et al. Association of hypermagnesemia and blood pressure in the critically ill. J Hypertension. 2013;31(11):2136.

Chernow B, Bamberger S, Stoiko M, Vadnais M, Mills S, Hoellerich V, et al. Hypomagnesemia in patients in postoperative intensive care. Chest. 1989;95(2):391-7.

Jiang P, Lv Q, Lai T, Xu F. Does hypomagnesemia impact on the outcome of patients admitted to the intensive care unit? A systematic review and meta-analysis. Shock: Injury, Inflammation, Sepsis: Lab Clin Approaches. 2017;47(3):288-95.