European Journal of Internal Medicine 25 (2014) e48–e49
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor Serum magnesium in postoperative patients admitted to the intensive care unit Keywords: Hypomagnesaemia Gastrointestinal Abdominal surgery
Magnesium (Mg2 +) is an important component of many body systems and is involved in ATP synthesis/hydrolysis, protein and nucleic acid synthesis and regulation of intracellular calcium and potassium [1]. Hypomagnesaemia (serum Mg2 + b 0.7 mmol/L) can induce arrhythmias, neurological irritability, exacerbation of digoxin toxicity and exacerbation of the effects of hypocalcaemia including paraesthesia, cramps, and prolonged Q–T interval. It is common in patients admitted to intensive care units (ICUs) [1–4]. Gastrointestinal malabsorption and/or losses are common causes of magnesium deficiency [1]. We performed a retrospective analysis of patients admitted to ICU following elective or emergency major abdominal surgery to examine the prevalence of this electrolyte disorder. We analysed the data by descriptive statistics using SPSS 20.0.0 (IBM SPSS Inc., Chicago, IL). We studied 87 patients (47 men) with a mean (standard deviation) age of 66.3 (15.5) years admitted to ICU following major abdominal surgery including 55 (63.2%) elective and 32 (36.8%) non-elective operations comprising colectomy in 40 (46.0%), anterior or abdominoperineal resection in 12 (13.8%), Hartmann's procedure in 7 (8.0%), small bowel resection in 6 (6.9%) and other abdominal operations in 22 (25.3%).
Median (range) serum Mg 2 + was 0.62 (0.28–1.64) mmol/L. Of the 87 patients, 61 (70.1%) had Mg 2 + b 0.7 mmol/L (Fig. 1a). Serum potassium was 4.20 (2.90–6.50) mmol/L. Age and serum potassium concentration were not correlated with serum Mg 2 + concentration (Fig. 1b). We report that over two-thirds of patients admitted to ICU after major abdominal surgery had hypomagnesaemia. Although hypomagnesaemia is rarely symptomatic [5], it is associated with higher postoperative mortality and morbidity, including respiratory problems due to muscle weakness, arrhythmias and neurocognitive dysfunction [6]. Some workers have explored the role of intravenous magnesium sulphate as an adjuvant during general anaesthesia [7]. However, there is no consensus at present whether all patients undergoing major general surgical procedures should be given magnesium supplementation peri-operatively. We conclude that serum magnesium should be routinely measured and corrected in patients undergoing major abdominal surgery.
Conflict of interests All authors declare that there is no conflict of interest in relation to the publication of this paper.
Acknowledgments We thank Dr. Bethan Hale for her contribution in collecting the data.
Fig. 1. Distribution of serum magnesium concentrations in patients admitted to intensive care unit following major abdominal surgery (panel a). There was no correlation between magnesium and potassium concentrations (panel b). 0953-6205/$ – see front matter © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ejim.2014.01.012
Letter to the Editor
References [1] Demssie YN, Patel L, Kumar M, Syed AA. Hypomagnesaemia: clinical relevance and management. Br J Hosp Med (Lond) 2014;75:39–43. [2] Reinhart RA, Desbiens NA. Hypomagnesemia in patients entering the ICU. Crit Care Med 1985;13:506–7. [3] Ryzen E, Wagers PW, Singer FR, Rude RK. Magnesium deficiency in a medical ICU population. Crit Care Med 1985;13:19–21. [4] Topf JM, Murray PT. Hypomagnesemia and hypermagnesemia. Rev Endocr Metab Disord 2003;4:195–206. [5] Place HM, Enzenauer RJ, Muff BJ, Ziporin PJ, Brown CW. Hypomagnesemia in postoperative spine fusion patients. Spine (Phila Pa 1976) 1996;21:2268–72. [6] Evans MD, Barton K, Pritchard GA, Williams EJ, Karandikar SS. Plasma magnesium should be monitored perioperatively in patients undergoing colorectal resection. Colorectal Dis 2009;11:613–8. [7] Gupta K, Vohra V, Sood J. The role of magnesium as an adjuvant during general anaesthesia. Anaesthesia 2006;61:1058–63.
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Thomas Selvaraj Department of Anaesthesia and Intensive Care, Warwick Hospital, Lakin Road, Warwick CV34 5BW, UK Corresponding author. Tel.: +44 7748006238. E-mail address: [email protected]. Akheel A. Syed Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
29 December 2013
Contents lists available at ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letter to the Editor Serum magnesium in postoperative patients admitted to the intensive care unit Keywords: Hypomagnesaemia Gastrointestinal Abdominal surgery
Magnesium (Mg2 +) is an important component of many body systems and is involved in ATP synthesis/hydrolysis, protein and nucleic acid synthesis and regulation of intracellular calcium and potassium [1]. Hypomagnesaemia (serum Mg2 + b 0.7 mmol/L) can induce arrhythmias, neurological irritability, exacerbation of digoxin toxicity and exacerbation of the effects of hypocalcaemia including paraesthesia, cramps, and prolonged Q–T interval. It is common in patients admitted to intensive care units (ICUs) [1–4]. Gastrointestinal malabsorption and/or losses are common causes of magnesium deficiency [1]. We performed a retrospective analysis of patients admitted to ICU following elective or emergency major abdominal surgery to examine the prevalence of this electrolyte disorder. We analysed the data by descriptive statistics using SPSS 20.0.0 (IBM SPSS Inc., Chicago, IL). We studied 87 patients (47 men) with a mean (standard deviation) age of 66.3 (15.5) years admitted to ICU following major abdominal surgery including 55 (63.2%) elective and 32 (36.8%) non-elective operations comprising colectomy in 40 (46.0%), anterior or abdominoperineal resection in 12 (13.8%), Hartmann's procedure in 7 (8.0%), small bowel resection in 6 (6.9%) and other abdominal operations in 22 (25.3%).
Median (range) serum Mg 2 + was 0.62 (0.28–1.64) mmol/L. Of the 87 patients, 61 (70.1%) had Mg 2 + b 0.7 mmol/L (Fig. 1a). Serum potassium was 4.20 (2.90–6.50) mmol/L. Age and serum potassium concentration were not correlated with serum Mg 2 + concentration (Fig. 1b). We report that over two-thirds of patients admitted to ICU after major abdominal surgery had hypomagnesaemia. Although hypomagnesaemia is rarely symptomatic [5], it is associated with higher postoperative mortality and morbidity, including respiratory problems due to muscle weakness, arrhythmias and neurocognitive dysfunction [6]. Some workers have explored the role of intravenous magnesium sulphate as an adjuvant during general anaesthesia [7]. However, there is no consensus at present whether all patients undergoing major general surgical procedures should be given magnesium supplementation peri-operatively. We conclude that serum magnesium should be routinely measured and corrected in patients undergoing major abdominal surgery.
Conflict of interests All authors declare that there is no conflict of interest in relation to the publication of this paper.
Acknowledgments We thank Dr. Bethan Hale for her contribution in collecting the data.
Fig. 1. Distribution of serum magnesium concentrations in patients admitted to intensive care unit following major abdominal surgery (panel a). There was no correlation between magnesium and potassium concentrations (panel b). 0953-6205/$ – see front matter © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ejim.2014.01.012
Letter to the Editor
References [1] Demssie YN, Patel L, Kumar M, Syed AA. Hypomagnesaemia: clinical relevance and management. Br J Hosp Med (Lond) 2014;75:39–43. [2] Reinhart RA, Desbiens NA. Hypomagnesemia in patients entering the ICU. Crit Care Med 1985;13:506–7. [3] Ryzen E, Wagers PW, Singer FR, Rude RK. Magnesium deficiency in a medical ICU population. Crit Care Med 1985;13:19–21. [4] Topf JM, Murray PT. Hypomagnesemia and hypermagnesemia. Rev Endocr Metab Disord 2003;4:195–206. [5] Place HM, Enzenauer RJ, Muff BJ, Ziporin PJ, Brown CW. Hypomagnesemia in postoperative spine fusion patients. Spine (Phila Pa 1976) 1996;21:2268–72. [6] Evans MD, Barton K, Pritchard GA, Williams EJ, Karandikar SS. Plasma magnesium should be monitored perioperatively in patients undergoing colorectal resection. Colorectal Dis 2009;11:613–8. [7] Gupta K, Vohra V, Sood J. The role of magnesium as an adjuvant during general anaesthesia. Anaesthesia 2006;61:1058–63.
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Thomas Selvaraj Department of Anaesthesia and Intensive Care, Warwick Hospital, Lakin Road, Warwick CV34 5BW, UK Corresponding author. Tel.: +44 7748006238. E-mail address: [email protected]. Akheel A. Syed Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
29 December 2013
