Magnesium disturbances in critically ill children

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Endocrinology
• Pediatric Nephrology

Background:

• Magnesium is crucial for cellular function, and its disturbances are frequently observed in critically ill patients.
• Understanding the prevalence and impact of magnesium imbalances in pediatric intensive care is essential for improving patient outcomes.

Purpose of the Study:

• To determine the incidence of magnesium disturbances (hypomagnesemia and hypermagnesemia) in children admitted to a Pediatric Intensive Care Unit (PICU).
• To investigate the association between these magnesium disturbances and clinical complications, including acute kidney injury (AKI), shock, extracorporeal membrane oxygenation (ECMO) use, and mortality.

Main Methods:

• A single-center, observational, retrospective study was conducted.
• Serum magnesium levels, clinical data, severity scores (FSS, PRISM, P-LOF, P-MODS), and outcomes were analyzed for 200 children admitted to the PICU.
• Prevalence of initial and in-admission hypomagnesemia and hypermagnesemia was assessed and correlated with clinical parameters and outcomes.

Main Results:

• Hypomagnesemia was present initially in 3% and during admission in 13% of children.
• In-admission hypomagnesemia was significantly associated with AKI (p=0.038), shock (p=0.003), and ECMO (p=0.046).
• Patients with hypomagnesemia experienced higher mortality (15.4% vs. 1.7%, p=0.006).
• Hypermagnesemia was observed initially in 32% and during admission in 44.5% of children.
• In-admission hypermagnesemia was linked to cardiac surgery (p<0.001) but not mortality (p=0.702).

Conclusions:

• Magnesium disturbances, both hypomagnesemia and hypermagnesemia, are prevalent in PICU admissions.
• In-hospital hypomagnesemia is a significant predictor of severe complications and mortality in critically ill children.
• Hypermagnesemia is associated with cardiac surgery but does not appear to impact mortality in this cohort.