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Ionized magnesium concentrations in critically ill children

R T Fiser1, A Torres, A W Butch

  • 1Wilford Hall Medical Center, Lackland AFB, TX 78236, USA.

Critical Care Medicine
|January 6, 1999
PubMed
Summary

Many critically ill children have low ionized magnesium (IMg) levels, even with normal total magnesium (TMg) levels. Standard TMg tests may miss this critical deficiency in pediatric intensive care patients.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Chemistry
  • Pediatric Endocrinology

Background:

  • Critically ill children may present with electrolyte imbalances.
  • Total magnesium (TMg) is routinely measured, but ionized magnesium (IMg) is the biologically active form.
  • Normal TMg levels do not always exclude magnesium deficiency.

Purpose of the Study:

  • To investigate the prevalence of ionized hypomagnesemia in critically ill children.
  • To determine if ionized hypomagnesemia occurs despite normal total magnesium concentrations.
  • To compare ionized magnesium levels in critically ill children with healthy children.

Main Methods:

  • Prospective, observational study involving convenience sampling.
  • Inclusion of critically ill children (1 day to 21 years) admitted to pediatric and cardiovascular intensive care units.

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  • Measurement of plasma ionized magnesium (IMg) and total magnesium (TMg) using a blood analyzer, with a comparison group of healthy children.

    • Main Results:

    • 59% of critically ill children had ionized hypomagnesemia (IMg <0.40 mmol/L).
    • Of those with hypomagnesemia, 60% had normal total magnesium concentrations.
    • Critically ill children showed significantly lower IMg levels than healthy children (0.37±0.10 mmol/L vs. 0.46±0.03 mmol/L).

    Conclusions:

    • Ionized hypomagnesemia is common in critically ill children, often undetected by standard TMg tests.
    • Routine TMg testing may fail to identify magnesium deficiency in this vulnerable population.
    • Critically ill children have demonstrably lower ionized magnesium levels compared to healthy peers.