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Magnesium metabolism after cardiac surgery in children
Santiago Mencía;1, Nieves De Lucas, Jesús López-Herce
1Pediatric Intensive Care Unit (SM, NDL, JLH, AC), Children's Laboratory (RM), and Preventive Medicine and Quality Control Service (GG), Gregorio Marañón General University Hospital, Madrid, Spain.
Insights
Children undergoing cardiac surgery experience decreased serum magnesium (MgS) and ultrafiltrable magnesium (MgU) levels upon intensive care unit admission. These magnesium levels gradually recover within five days post-surgery.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Clinical chemistry and metabolism
Background:
- Magnesium is crucial for cardiac function and cellular processes.
- Cardiac surgery and extracorporeal circulation can significantly impact electrolyte balance.
- Understanding magnesium shifts in pediatric cardiac surgery patients is vital for optimizing care.
Purpose of the Study:
- To investigate magnesium metabolism in children during the perioperative period of cardiac surgery.
- To analyze the dynamics of serum magnesium (MgS) and ultrafiltrable magnesium (MgU) levels post-cardiac surgery.
- To explore correlations between magnesium levels and clinical outcomes in pediatric patients.
Main Methods:
- A prospective observational study involving 42 children undergoing cardiac surgery.
- Serial measurements of serum magnesium, ultrafiltrable magnesium, intraerythrocytic magnesium, and urinary magnesium.
- Analysis included blood and urinary calcium, phosphorus, sodium, and creatinine.
- Data collected pre-surgery, at PICU admission, and at 24 hours, 3 days, and 5 days post-surgery.
Main Results:
- Serum magnesium (MgS) and ultrafiltrable magnesium (MgU) levels significantly decreased after cardiac surgery, particularly after extracorporeal circulation.
- At PICU admission, a high percentage of patients exhibited low MgS (61.5%) and MgU (47.2%) levels.
- MgS and MgU levels demonstrated a significant increase from 24 hours up to 5 days post-surgery.
- No significant changes were observed in intraerythrocytic magnesium levels.
- No correlation was found between magnesium levels and clinical parameters like age, sex, diagnosis, surgery type, arrhythmias, complications, length of stay, or mortality.
Conclusions:
- Children undergoing cardiac surgery, especially with extracorporeal circulation, experience significant reductions in serum and ultrafiltrable magnesium upon PICU admission.
- Magnesium levels tend to recover and increase during the first five days following cardiac surgery.
- The study found no direct relationship between perioperative magnesium levels and the postoperative clinical course or complications in this pediatric cohort.
Abstract:
OBJECTIVE: To analyze magnesium metabolism in children after cardiac surgery. DESIGN: Prospective observational study. SETTING: Pediatric intensive care unit (PICU) of a university hospital. PATIENTS: A total of 42 children in the perioperative period of cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Determinations of serum magnesium (MgS), ultrafiltrable magnesium (MgU), intraerythrocytic magnesium, urinary magnesium, blood and urinary calcium, phosphorus, sodium, and blood and urinary creatinine were made in the operating room before surgery, at admission to the PICU, at 24 hrs, and at 3 and 5 days after surgery. The relationship with age, sex, diagnosis, type of surgery, arrhythmias, complications, length of stay in the PICU, and mortality was analyzed. MgS and MgU levels decreased after cardiac surgery (MgS before surgery, 0.74 +/- 0.09 mmol/L; MgS at admission to the PICU, 0.66 +/- 0.11 mmol/L; MgU before surgery, 0.56 +/- 0.06 mmol/L; MgU at admission to the PICU, 0.50 +/- 0.07 mmol/L; p <.0001 for both values). At admission to the PICU, 61.5% of the patients had MgS of <0.63 mmol/L, and 47.2% of the patients had an MgU of <0.46 mmol/L. MgS and MgU had increased by 24 hrs and showed further increases over the first 5 days after surgery. There were no significant changes in the intraerythrocytic magnesium levels in the postoperative period. Changes of MgS and MgU were greater after extracorporeal circulation than after closed surgery (p <.001). There was no correlation between MgS, MgU, or intraerythrocytic magnesium and other analytic and clinical parameters. No patient presented arrhythmias and none died. CONCLUSIONS: After cardiac surgery, and particularly after extracorporeal circulation surgery, children present with low MgS and MgU levels at admission to the PICU. MgS and MgU levels increase over the first 5 days after cardiac surgery. No relationship was found between magnesium levels and the postoperative course.