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Ionized Blood Magnesium in Sick Children: An Overlooked Electrolyte
Pradeep Kumar Dabla1, Shikha Sharma2, Aashima Dabas3
1Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), Associated to Maulana Azad Medical College, New Delhi, India.
Insights
Abnormal magnesium levels are common in critically ill children, with hypomagnesemia linked to other electrolyte issues. Both low and high magnesium were observed, impacting patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Chemistry
- Electrolyte Balance
Background:
- Magnesium is an under-monitored electrolyte in pediatric critical care.
- Hypomagnesemia is linked to increased mechanical ventilation, mortality, and prolonged ICU stays in critically ill patients.
- Understanding magnesium levels in children is crucial for predicting disease outcomes.
Purpose of the Study:
- To determine the prevalence of abnormal magnesium levels in hospitalized children.
- To correlate magnesium levels with clinical outcomes such as hospitalization duration and mortality.
- To investigate associations between magnesium and other electrolyte disturbances.
Main Methods:
- Observational study of 154 children (1 month to 12 years) admitted to the emergency room.
- Ionized magnesium, calcium, sodium, and potassium levels measured using Stat Profile Prime Plus.
- Clinical outcomes including hospitalization duration, mortality, and need for ventilation were recorded.
Main Results:
- 39.6% of children had hypomagnesemia, and 19.4% had hypermagnesemia.
- Hypomagnesemia was significantly associated with hypocalcemia, hyponatremia, and hypokalemia.
- While hypermagnesemia showed a trend towards higher ventilation and mortality rates, hypomagnesemia was linked to more electrolyte abnormalities.
Conclusions:
- Both hypomagnesemia and hypermagnesemia occur in critically ill children.
- Hypomagnesemia is frequently accompanied by other significant electrolyte imbalances.
- Monitoring magnesium levels is important for assessing critically ill children.
Introduction:
Magnesium is a less frequently monitored electrolyte in critically ill patients. Hypomagnesemia is associated with increased need for mechanical ventilation, mortality and prolonged ICU stay. The present study was undertaken to identify the proportion of children with abnormal magnesium levels and correlate it with disease outcome.
Methods:
This observational study included children aged 1 month to 12 years hospitalized at the emergency room. Heparinized blood was collected for determination of ionized magnesium, ionized calcium, sodium, potassium and lactate using Stat Profile Prime Plus (Nova Biomedical, Waltham, MA, USA). Clinical outcomes for duration of hospitalization, and death or discharge were recorded.
Results:
A total of 154 (102 males) children with median (IQR) age of 11 (4, 49.75) months were enrolled. Sixty one (39.6%) had ionized magnesium levels below 0.42 mmol/l, 63 (40.9%) had normal levels and 30 (19.4%) had hypermagnesemia (>0.59 mmol/l). Hypomagnesemia was associated with hypocalcemia (p < 0.001), hyponatremia (p < 0.001) and hypokalemia (p < 0.02). A higher proportion of children with hypermagnesemia required ventilation than hypomagnesemia (26% vs. 9%) and succumbed (35% vs. 20%), respectively; p > 0.05. Ninety-three (60.3%) had hypocalcemia and 10 (6.5%) children had hypercalcemia. There was good correlation between ionized calcium and magnesium values (r = 0.72, p < 0.001).
Conclusion:
Both hypomagnesemia and hypermagnesemia were seen in critically ill children. Patients with hypomagnesemia had significantly higher proportion of other electrolyte abnormalities.
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