A Study of Hypomagnesemia in Patients Admitted to the ICU

Abstract

Introduction After potassium, magnesium (Mg2+) is the most prevalent cation found intracellularly in the human body. The maintenance of excitability by Mg2+ and other cations is crucial for the neuromuscular junction to operate normally. Magnesium shortages are frequently overlooked compared to other electrolyte disorders such as hyponatremia, hypokalemia, and hypocalcemia. The present study aimed to study the factors and effects of hypomagnesemia among intensive care unit (ICU) patients who are critically ill at a tertiary care hospital. Methods This is a prospective observational study done among the patients who got admitted to the Medical ICU at Maharajahs Institute of Medical Sciences (MIMS), Nellimarla, Vizianagaram, from January 2020 to June 2021. A total of 100 patients were included in the study, of which 50 were cases and 50 were controls. The cases are those patients admitted to the medical ICU with critical illness and hypomagnesemia, and the controls are selected from those patients admitted with critical illness to the medical ICU with normal magnesium levels. Patients with severe infections, including sepsis, respiratory failure, cardiac failure, renal failure, cerebrovascular accidents (CVA), poisonings, and diabetic ketoacidosis (DKA), were included in the study. Patients who were treated with magnesium before admission to our ICU were excluded from this study. Serum magnesium was tested within 24 hours of admission and is correlated with the outcomes of the patients in terms of APACHE II score, length of ICU stay, and requirement and duration of ventilatory support. Results Out of a total of 50 cases, 29 (58%) are of males. The mean age of cases was 57.6 ∓ 8.2 years. Most cases were admitted due to organ failure (30%), followed by sepsis (26%) and poisoning (22%). The mean magnesium levels were 1.19 mg/dL among the cases, which was significantly lower when compared to the control group (2.16 mg/dL) (p-value= 0.01). The mean length of stay in the ICU was 6.12∓5.16 days in cases, whereas it was 5.28∓3.37 days in the control group (p-value = 0.33). 12% of cases needed non-invasive ventilation (NIV) when compared to 8% of controls (p-value= 0.50). 48% of the cases needed invasive ventilator support when compared to 28% in the control group (p-value= 0.03). The duration of invasive ventilation was higher among the cases (mean = 10 ∓3-17 days) compared to the controls (mean = 3 ∓2-4 days); p-value = 0.001. Mortality was higher in the case group at 28% (14) and was 10% (5) in the control group (p-value = 0.02). Conclusion The need for invasive ventilation and duration of invasive ventilation were significantly higher among the patients with hypomagnesemia compared to the patients with normal magnesium levels (p-value <0.05). Mortality was higher in the cases than in the controls (p-value <0.05).