Investigating the Agreement of Hypomagnesemia Diagnosis in Three Perimeter of Serum, Urine, and Red Blood Cell in Intensive Care Unit: Pilot Study
-
Nastaran Nazarzade
,
Mojtaba Mojtahedzadeh
,
Farshid Gholami
,
Amirmahdi Mojtahedzadeh
,
Maryam Shiehmorteza
,
Amirhossein Ghanbarzamani
Abstract
Background: Magnesium is a vital element in the body involved in biochemical and physiological processes. Magnesium deficiency can lead to serious consequences including cardiac, neurological, muscular disorders, and other clinical manifestations. In our country, commonly, magnesium measurement is done by measuring serum magnesium levels. This paper discusses the prevalence and consequences of magnesium deficiency in patients hospitalized in the ICU and emphasizes the importance of diagnosis and treating hypomagnesemia.
Methods: Diagnosis of hypomagnesemia is done by measuring serum magnesium, urine magnesium, and magnesium in RBCs. We conducted a prospective study on 30 critically ill patients (14 male, and 16 female) who were admitted to the ICU to examine the prevalence of magnesium deficiency. In eligible patients, after measuring serum and RBC magnesium levels, 7.5 grams of magnesium sulfate in 1000 ml isotonic saline was infused over 8 hours at a rate of 125 ml/hour and urine was collected for 24 hours from the start of the infusion.
Results: The mean age was 71. There was a significant difference between the levels of serum Mg and RBC Mg (U statistic = 266 and P<0.05). The results showed a significant difference between the levels of serum Mg and urinary Mg (U statistic was almost 0 and P<0.05). The results indicated a significant difference between the levels of urinary Mg and RBC Mg (U statistic was almost 0 and P<0.05).
Conclusion: There is no correlation between serum magnesium and the body’s magnesium requirement in patients, and serum magnesium does not reflect the actual status of patients in the ICU. Therefore, measuring the level of magnesium in red blood cells is preferable to urinary magnesium and serum magnesium to investigate hypomagnesemia in the ICU. Additionally, there is no correlation between age, gender, APACHE II score, and the percentage of infused magnesium absorption in patients.
[1] Zafar MS, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill-patients. Int J Appl Basic Med Res. 2014; 4(1):34-7.
[2] Fairley J, Glassford NJ, Zhang L, Bellomo R. Magnesium status and magnesium therapy in critically ill patients: A systematic review. J Crit Care. 2015; 30(6):1349-58.
[3] Deheinzelin D, Negri E, Tucci M, Salem M, Da Cruz V, Oliveira R, et al. Hypomagnesemia in critically ill cancer patients: a prospective study of predictive factors. Braz J Med Biol Res. 2000; 33:1443-8.
[4] Salem M, Munoz R, Chernow B. Hypomagnesemia in critical illness: a common and clinically important problem. Crit Care Clin. 1991; 7(1):225-52.
[5] Dickerson R, Brown R. Hypomagnesemia in hospitalized patients receiving nutritional support. Heart Lung. 1985; 14(6):561-9.
[6] Flink EB. Therapy of magnesium deficiency. Annals of the New York Academy of Sciences. 1969; 162(2):901-5.
[7] Gupta S, Sodhi S, Kaur J, Yamini J. Improvement in electrolyte imbalance in critically ill patient after magnesium supplementation—A case report. Indian J Clin Biochem.2009; 24:208-10.
[8] Hansen B-A, Bruserud Ø. Hypomagnesemia in critically ill patients. J Intensive Care. 2018; 6:1-11.
[9] Romani AM. Cellular magnesium homeostasis. Arch Biochem Biophys. 2011; 512(1):1-23.
[10] Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003; 24(2):47-66.
[11] Weisinger JR, Bellorín-Font E. Magnesium and phosphorus. The Lancet. 1998; 352(9125):391-6.
[12] Reinhart RA. Magnesium metabolism: a review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med. 1988; 148(11):2415-20.
[13] Wacker WE, Parisi AF. Magnesium metabolism. New England Journal of Medicine. 1968; 278(13):712-7.
[14] Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7(9):8199-226.
[15] Gonzales W, Altieri P, Alvarado S, Banchs H, Escobales N, Crespo M, Borges W. Magnesium: the forgotten electrolyte. Bol. Asoc. Med PR. 2013; 105(3):17-20.
[16] Elin RJ. Magnesium: the fifth but forgotten electrolyte. Am J Clin Pathol. 1994; 102(5):616-22.
[17] Rob P, Dick K, Bley N, Seyfert T, Brinckmann C, Höllriegel V, et al. Can one really measure magnesium deficiency using the short‐term magnesium loading test? J Intern Med. 1999; 246(4):373-8.
[18] Gragossian A, Bashir K, Bhutta BS, Friede R. Hypomagnesemia. 2023 Nov 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
[19] Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in critically ill sepsis patients. J Clin Med Res. 2015; 7(12):911-8.
[20] Upala S, Jaruvongvanich V, Wijarnpreecha K, Sanguankeo A. Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis. QJM. 2016; 109(7):453-459.
[21] Kumar S, Honmode A, Jain S, Bhagat V. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India. Indian J Crit Care Med. 2015; 19(7):379-83.
[22] Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India. 2011; 59:19-22.
[23] Safavi M, Honarmand A. Admission hypomagnesemia--impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol. 2007; 19(3):645-60.
[24] Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med. 1993; 21(2):203-9.
[25] Ryan M, Barbour H. Magnesium measurement in routine clinical practice. Ann Clin Biochem. 1998; 35(4):449-59.
[26] Arnaud MJ. Update on the assessment of magnesium status. Britis Br J Nutr. 2008; 99(S3):S24-S36.
[27] Sedighi M, Pourpak Z, Bavarian B, Safaralizadeh R, Zare A, Moin M. Low magnesium concentration in erythrocytes of children with acute asthma. Iran J Allergy Asthma Immunol. 2006; 5(4):183-6.
[28] Koebnick C, Leitzmann R, Garcia A, Heins U, Heuer T, Golf S, et al. Long-term effect of a plant-based diet on magnesium status during pregnancy. Eur J Clin Nutr. 2005; 59(2):219-25.
[29] Kieboom BC, Ligthart S, Dehghan A, Kurstjens S, de Baaij JH, Franco OH, et al. Serum magnesium and the risk of prediabetes: a population-based cohort study. Diabetologia. 2017; 60(5):843-53.
[30] Malinowska J, Małecka M, Ciepiela O. Variations in magnesium concentration are associated with increased mortality: study in an unselected population of hospitalized patients. Nutrients. 2020; 12(6):1836.
[31] Dyckner T, Wester P. The relation between extra‐and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. Acta Med Scand. 1978; 204(1‐6):269-82.
[32] Koivisto M, Valta P, Höckerstedt K, Lindgren L. Magnesium depletion in chronic terminal liver cirrhosis. Clin Transplant. 2002; 16(5):325-8.
[33] Hebert P, Mehta N, Wang J, Hindmarsh T, Jones G, Cardinal P. Functional magnesium deficiency in critically ill patients identified using a magnesium-loading test. Crit Care Med. 1997; 25(5):749-55.
[34] Gullestad L, Dolva LO, Waage A, Falch D, Fagerthun H, Kjekshus J. Magnesium deficiency diagnosed by an intravenous loading test. Scand J Clin Lab Invest. 1992; 52(4):245-53.
[35] Gullestad L, Midtvedt K, Dolva LO, Norseth J, Kjekshus J. The magnesium loading test: reference values in healthy subjects. Scand J Clin Lab Invest. 1994; 54(1):23-31.
[36] Papazachariou IM, Martinez-Isla A, Efthimiou E, Williamson RC, Girgis SI. Magnesium deficiency in patients with chronic pancreatitis identified by an intravenous loading test. Clin Chim Acta. 2000; 302(1-2):145-54.
[37] Sohrevardi S, Mojtahedzadeh M, Sadray S, Najafi A, Spence J, Munoz C, etal. Role of magnesium loading test in detecting hypomagnesemia in critically Ill patients. 2004.
[38] Humphrey S, Kirby R, Rudloff E. Magnesium physiology and clinical therapy in veterinary critical care. J Vet Emerg Crit Care (San Antonio). 2015; 25(2):210-25.
[39] Kvarantan T, Bosman R, Oudemans-van Straaten H. Severe hypomagnesaemia in the intensive care unit. Hospital. 2014; 8(52):15496.
[40] Arnold A, Tovey J, Mangat P, Penny W, Jacobs S. Magnesium deficiency in critically ill patients. Anaesthesia. 1995;50(3):203-5.
[41] Torralbo A, Portoles J, Perez A-JP, Barrientos A. Hypomagnesemic hypocalcemia in chronic renal failure. Am J Kidney Dis. 1993; 21(2):167-71.
[42] Pham P-CT, Pham P-AT, Pham SV, Pham P-TT, Pham P-MT, Pham P-TT. Hypomagnesemia: a clinical perspective. Int J Nephrol Renovasc Dis. 2014:219-30.
[43] De Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015; 95(1):1-46.
[44] Dayoub EJ, Jena AB, editors. Does pain lead to tachycardia? Revisiting the association between self-reported pain and heart rate in a national sample of urgent emergency department visits. Mayo Clinic Proceedings; 2015: Elsevier.
[45] Longo DL. Harrisons principles of internal medicine. 2012.
[46] Shin H-J, Na H-S, Do S-H. Magnesium and pain. Nutrients. 2020;12(8):2184.
[47] Delhumeau A, Granry J, Cottineau C, Bukowski J, Corbeau J, Moreau X, editors. Comparison of vascular effects of magnesium sulfate and nicardipine during extracorporeal circulation. Annales Francaises d'anesthesie et de Reanimation; 1995.
[48] Rosique-Esteban N, Guasch-Ferré M, Hernández-Alonso P, Salas-Salvadó J. Dietary magnesium and cardiovascular disease: a review with emphasis in epidemiological studies. Nutrients. 2018; 10(2):168.
[49] Yousif OO, Hassan MaK, Al-Naama LM. Red blood cell and serum magnesium levels among children and adolescents with sickle cell anemia. Biological Trace Element Research. 2018; 186:295-304.
[50] Vanroelen WF, Van Gaal LF, Van Rooy PE, de Leeuw IH. Serum and erythrocyte magnesium levels in type I and type II diabetics. Acta diabetologia latina. 1985; 22:185-90.
[51] Huijgen HJ, Soesan M, Sanders R, Mairuhu WM, Kesecioglu J, Sanders GT. Magnesium levels in critically ill patients: What should we measure? Am J Clin Pathol. 2000; 114(5):688-95.
[52] Vizinová H, Bártek J, Jirka Z, Steidl L. The oral magnesium loading test for detecting possible magnesium deficiency. Cas Lek Cesk. 1993; 132(19):587-9.
[53] Spisák V. Magnesium loading test in cardiovascular diseases. Vnitr Lek. 1992; 38(4):337-44.
[2] Fairley J, Glassford NJ, Zhang L, Bellomo R. Magnesium status and magnesium therapy in critically ill patients: A systematic review. J Crit Care. 2015; 30(6):1349-58.
[3] Deheinzelin D, Negri E, Tucci M, Salem M, Da Cruz V, Oliveira R, et al. Hypomagnesemia in critically ill cancer patients: a prospective study of predictive factors. Braz J Med Biol Res. 2000; 33:1443-8.
[4] Salem M, Munoz R, Chernow B. Hypomagnesemia in critical illness: a common and clinically important problem. Crit Care Clin. 1991; 7(1):225-52.
[5] Dickerson R, Brown R. Hypomagnesemia in hospitalized patients receiving nutritional support. Heart Lung. 1985; 14(6):561-9.
[6] Flink EB. Therapy of magnesium deficiency. Annals of the New York Academy of Sciences. 1969; 162(2):901-5.
[7] Gupta S, Sodhi S, Kaur J, Yamini J. Improvement in electrolyte imbalance in critically ill patient after magnesium supplementation—A case report. Indian J Clin Biochem.2009; 24:208-10.
[8] Hansen B-A, Bruserud Ø. Hypomagnesemia in critically ill patients. J Intensive Care. 2018; 6:1-11.
[9] Romani AM. Cellular magnesium homeostasis. Arch Biochem Biophys. 2011; 512(1):1-23.
[10] Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003; 24(2):47-66.
[11] Weisinger JR, Bellorín-Font E. Magnesium and phosphorus. The Lancet. 1998; 352(9125):391-6.
[12] Reinhart RA. Magnesium metabolism: a review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med. 1988; 148(11):2415-20.
[13] Wacker WE, Parisi AF. Magnesium metabolism. New England Journal of Medicine. 1968; 278(13):712-7.
[14] Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7(9):8199-226.
[15] Gonzales W, Altieri P, Alvarado S, Banchs H, Escobales N, Crespo M, Borges W. Magnesium: the forgotten electrolyte. Bol. Asoc. Med PR. 2013; 105(3):17-20.
[16] Elin RJ. Magnesium: the fifth but forgotten electrolyte. Am J Clin Pathol. 1994; 102(5):616-22.
[17] Rob P, Dick K, Bley N, Seyfert T, Brinckmann C, Höllriegel V, et al. Can one really measure magnesium deficiency using the short‐term magnesium loading test? J Intern Med. 1999; 246(4):373-8.
[18] Gragossian A, Bashir K, Bhutta BS, Friede R. Hypomagnesemia. 2023 Nov 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
[19] Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in critically ill sepsis patients. J Clin Med Res. 2015; 7(12):911-8.
[20] Upala S, Jaruvongvanich V, Wijarnpreecha K, Sanguankeo A. Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis. QJM. 2016; 109(7):453-459.
[21] Kumar S, Honmode A, Jain S, Bhagat V. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India. Indian J Crit Care Med. 2015; 19(7):379-83.
[22] Limaye CS, Londhey VA, Nadkart MY, Borges NE. Hypomagnesemia in critically ill medical patients. J Assoc Physicians India. 2011; 59:19-22.
[23] Safavi M, Honarmand A. Admission hypomagnesemia--impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol. 2007; 19(3):645-60.
[24] Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med. 1993; 21(2):203-9.
[25] Ryan M, Barbour H. Magnesium measurement in routine clinical practice. Ann Clin Biochem. 1998; 35(4):449-59.
[26] Arnaud MJ. Update on the assessment of magnesium status. Britis Br J Nutr. 2008; 99(S3):S24-S36.
[27] Sedighi M, Pourpak Z, Bavarian B, Safaralizadeh R, Zare A, Moin M. Low magnesium concentration in erythrocytes of children with acute asthma. Iran J Allergy Asthma Immunol. 2006; 5(4):183-6.
[28] Koebnick C, Leitzmann R, Garcia A, Heins U, Heuer T, Golf S, et al. Long-term effect of a plant-based diet on magnesium status during pregnancy. Eur J Clin Nutr. 2005; 59(2):219-25.
[29] Kieboom BC, Ligthart S, Dehghan A, Kurstjens S, de Baaij JH, Franco OH, et al. Serum magnesium and the risk of prediabetes: a population-based cohort study. Diabetologia. 2017; 60(5):843-53.
[30] Malinowska J, Małecka M, Ciepiela O. Variations in magnesium concentration are associated with increased mortality: study in an unselected population of hospitalized patients. Nutrients. 2020; 12(6):1836.
[31] Dyckner T, Wester P. The relation between extra‐and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. Acta Med Scand. 1978; 204(1‐6):269-82.
[32] Koivisto M, Valta P, Höckerstedt K, Lindgren L. Magnesium depletion in chronic terminal liver cirrhosis. Clin Transplant. 2002; 16(5):325-8.
[33] Hebert P, Mehta N, Wang J, Hindmarsh T, Jones G, Cardinal P. Functional magnesium deficiency in critically ill patients identified using a magnesium-loading test. Crit Care Med. 1997; 25(5):749-55.
[34] Gullestad L, Dolva LO, Waage A, Falch D, Fagerthun H, Kjekshus J. Magnesium deficiency diagnosed by an intravenous loading test. Scand J Clin Lab Invest. 1992; 52(4):245-53.
[35] Gullestad L, Midtvedt K, Dolva LO, Norseth J, Kjekshus J. The magnesium loading test: reference values in healthy subjects. Scand J Clin Lab Invest. 1994; 54(1):23-31.
[36] Papazachariou IM, Martinez-Isla A, Efthimiou E, Williamson RC, Girgis SI. Magnesium deficiency in patients with chronic pancreatitis identified by an intravenous loading test. Clin Chim Acta. 2000; 302(1-2):145-54.
[37] Sohrevardi S, Mojtahedzadeh M, Sadray S, Najafi A, Spence J, Munoz C, etal. Role of magnesium loading test in detecting hypomagnesemia in critically Ill patients. 2004.
[38] Humphrey S, Kirby R, Rudloff E. Magnesium physiology and clinical therapy in veterinary critical care. J Vet Emerg Crit Care (San Antonio). 2015; 25(2):210-25.
[39] Kvarantan T, Bosman R, Oudemans-van Straaten H. Severe hypomagnesaemia in the intensive care unit. Hospital. 2014; 8(52):15496.
[40] Arnold A, Tovey J, Mangat P, Penny W, Jacobs S. Magnesium deficiency in critically ill patients. Anaesthesia. 1995;50(3):203-5.
[41] Torralbo A, Portoles J, Perez A-JP, Barrientos A. Hypomagnesemic hypocalcemia in chronic renal failure. Am J Kidney Dis. 1993; 21(2):167-71.
[42] Pham P-CT, Pham P-AT, Pham SV, Pham P-TT, Pham P-MT, Pham P-TT. Hypomagnesemia: a clinical perspective. Int J Nephrol Renovasc Dis. 2014:219-30.
[43] De Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015; 95(1):1-46.
[44] Dayoub EJ, Jena AB, editors. Does pain lead to tachycardia? Revisiting the association between self-reported pain and heart rate in a national sample of urgent emergency department visits. Mayo Clinic Proceedings; 2015: Elsevier.
[45] Longo DL. Harrisons principles of internal medicine. 2012.
[46] Shin H-J, Na H-S, Do S-H. Magnesium and pain. Nutrients. 2020;12(8):2184.
[47] Delhumeau A, Granry J, Cottineau C, Bukowski J, Corbeau J, Moreau X, editors. Comparison of vascular effects of magnesium sulfate and nicardipine during extracorporeal circulation. Annales Francaises d'anesthesie et de Reanimation; 1995.
[48] Rosique-Esteban N, Guasch-Ferré M, Hernández-Alonso P, Salas-Salvadó J. Dietary magnesium and cardiovascular disease: a review with emphasis in epidemiological studies. Nutrients. 2018; 10(2):168.
[49] Yousif OO, Hassan MaK, Al-Naama LM. Red blood cell and serum magnesium levels among children and adolescents with sickle cell anemia. Biological Trace Element Research. 2018; 186:295-304.
[50] Vanroelen WF, Van Gaal LF, Van Rooy PE, de Leeuw IH. Serum and erythrocyte magnesium levels in type I and type II diabetics. Acta diabetologia latina. 1985; 22:185-90.
[51] Huijgen HJ, Soesan M, Sanders R, Mairuhu WM, Kesecioglu J, Sanders GT. Magnesium levels in critically ill patients: What should we measure? Am J Clin Pathol. 2000; 114(5):688-95.
[52] Vizinová H, Bártek J, Jirka Z, Steidl L. The oral magnesium loading test for detecting possible magnesium deficiency. Cas Lek Cesk. 1993; 132(19):587-9.
[53] Spisák V. Magnesium loading test in cardiovascular diseases. Vnitr Lek. 1992; 38(4):337-44.
| Files | ||
| Issue | Vol 11 No 1 (2025): Winter |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v11i1.17490 | |
| Keywords | ||
| Hypomagnesemia Serum magnesium RBC magnesium Urine magnesium Intensive care unit | ||
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How to Cite
1.
Nazarzade N, Mojtahedzadeh M, Gholami F, Mojtahedzadeh A, Shiehmorteza M, Ghanbarzamani A. Investigating the Agreement of Hypomagnesemia Diagnosis in Three Perimeter of Serum, Urine, and Red Blood Cell in Intensive Care Unit: Pilot Study. Arch Anesth & Crit Care. 2024;11(1):53-59.
