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Hypo- and hypermagnesemia in an Indian Pediatric Intensive Care Unit
Sunit C Singhi1, Jagjit Singh, Rajendra Prasad
1Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsinghi@glide.net.in
Insights
Hypomagnesaemia (low magnesium) is common in critically ill children, affecting 60% of patients. Low magnesium levels significantly increase mortality risk in the paediatric intensive care unit (PICU).
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Biochemistry
- Electrolyte Disturbances
Background:
- Magnesium disturbances in critically ill children are underreported, particularly in developing nations.
- Limited data exists on the incidence and outcomes associated with hypo- and hypermagnesemia in pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate the occurrence and incidence of magnesium imbalances (hypomagnesemia and hypermagnesemia) in critically ill children.
- To determine the correlation between these magnesium disturbances and patient outcomes, including mortality.
Main Methods:
- A consecutive cohort of 100 children admitted to a PICU was studied.
- Serum and red blood cell (RBC) magnesium levels were measured at admission and every alternate day, along with other electrolytes and blood gases.
- Ethical approval and informed consent were obtained prior to data collection.
Main Results:
- Hypomagnesemia occurred in 60% of patients, while hypermagnesemia was observed in 4%.
- The incidence rates were 30.1 and 2 episodes per 100 patient days for hypomagnesemia and hypermagnesemia, respectively.
- Hypomagnesemia was most prevalent in patients with raised intracranial pressure and was associated with a nine-fold increase in mortality.
- Concurrent low magnesium and calcium levels further elevated mortality rates.
Conclusions:
- Hypomagnesemia and low red blood cell magnesium are frequent findings in PICU patients.
- These magnesium disturbances are significantly associated with increased mortality in critically ill children.
Abstract:
Data on magnesium disturbances in critically ill children admitted to a Paediatric Intensive Care Unit (PICU) are scarce, especially from developing countries. We have studied occurrence and incidence of hypo- and hypermagnesaemia in children admitted to a PICU and the correlation between such disturbances and the outcome of illness. A total of 100 children (68 boys, 32 girls) aged 6 months to 12 years (mean +/- SD 4.9 + 3.5 years) admitted consecutively to a PICU were studied. At admission and on every alternate day venous blood was obtained for the estimation of serum and RBC-magnesium, serum calcium, sodium, and potassium, and arterial blood for ionized calcium and pH. This was done after ethical approval and informed consent. Hypomagnesaemia and hypermagnesaemia occurred in 60 per cent and 4 per cent of patients, respectively. The incidence of hypomagnesaemia was 30.1, and hypermagnesaemia was two episodes per 100 patient days. The incidence of low RBC-Mg was 17.3 episodes per 100 patient days. Hypomagnesaemia was most common in patients with raised intracranial pressure (63 episodes per 100 patients days). Mortality was nine-fold higher in hypomagnesaemic (30 per cent, 19 of 63) compared with normomagnaesemic (3.3 per cent, one of 30) patients. If Mg and Ca both were low, the mortality rate was 33 per cent (15 of 45 patients) in contrast to nil if both were normal (p < 0.05). We conclude that hypomagnesaemia and low RBC-Mg are a common occurrence in PICU patients and are associated with higher mortality.