DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192031

Hypomagnesemia as a predictor of mortality in critically ill pediatric patients in picu using prism score

Poornima Shankar, N. Varsha Monica Reddy, Shiva Devaraj

Abstract


Background: Magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation after potassium. A potential relationship between low magnesium levels and increased mortality has been suggested in the literature. The objectives were to detect prevalence of hypomagnesemia in critically ill children, its association with sepsis and to correlate this with mortality.

Methods: This study was an observational study done on 100 children who met the inclusion criteria, admitted to the PICU of Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India. Patients under the study were managed and treated according to their clinical status and supportive traditional treatment.

Results: Prevalence of hypomagnesemia in critically ill pediatric patients was 53%. In this study, majority of the cases admitted to PICU were dengue (19%) and bronchopneumonia (15%) which were significantly associated with hypomagnesemia as p value was less than 0.05. As regard prognosis, Mg had an AUC of 0.576 for prediction of mortality whereas the AUC for PRISM score was 0.811. Logistic regression analysis showed that hypomagnesemia is a significant predictor for mortality among critically ill children (p value=0.028) and OR=3.180 (0.854-7.965).

Conclusions: Present study has found high prevalence of hypomagnesemia in critically ill patients. Hypomagnesemia was associated with a higher mortality rate in critically ill patients and commonly associated with infections and respiratory diseases. Hypomagnesemia indicated poor outcome and higher mortality rates in critically ill patients.


Keywords


Critically ill patients, Hypomagnesemia, PICU

Full Text:

PDF

References


Schwalfenberg GK and Genuis SJ. The Importance of magnesium in clinical healthcare. Sci (Cairo). 2017;4179326.

González EP, Rodriquez SF, Garcia CE. Magnesium homeostasis. Etiopathogeny, clinical diagnosis and treatment of hypomagnesaemia: a case study. Nefrol. 2009;29(6):518-24.

Elin RJ. Assessment of magnesium status. Clin Chem. 1987;33:1965-70.

Pham PC, Pham PA, Pham SV, Pham PM, Pham PT. Hypomagnesemia: a clinical perspective. Int J Nephrol Renovasc Dis. 2014;7:219-30.

Hansen BA, Bruserud Q. Hypomagnesemia in critically ill patients. Hansen and Bruserud. J Intensive Care. 2018;6:21.

Fine KD, Santa Ana CA, Porter JL, Fordtran JS. Intestinal absorption of magnesium from food and supplements. J Clin Invest. 1991;88:396-402.

Schweigel M, Martens H. Magnesium transport in the gastrointestinal tract. Front Biosci. 2000;5:D666-77.

Murray PM, Ruttimann UE, Getson PR. Pediatric risk of mortality score. Crit Care Med. 1988;16(11):1110-6.

Samantha L, Romani AMP. Role of cellular magnesium in human diseases. Austin J Nutrition Food Sci. 2014;2(10):1051.

Kumar D, Bhattacharya A, Ghosh D, Chakraborty M. Prevalence of hypomagnesemia and its predictive prognostic value in critically ill medical patients. IOSR J Pharmacy. 2014;(4)1:1-5.

Soliman HM, Mercan D, Lobo SS, Mélot C, Vincent JL. Development of ionized hypomagnesemia is associated with higher mortality rates. Crit Care Med. 2003;31(4):1082-7.

Fatih D, Altun Y, Kılınc F. Hypomagnesemia in internal care unit. Int J Basic Clin Studies. 2013;1(1):180-9.

Safavi M, Honarmand A. Admission hypomagnesemia impact on mortality or morbidity in critically ill patients. Middle East J Anesthesiol. 2007;19(3):645-60.

Mir ZSH, Wani JI, Karim R, Mir MM, Koul PA. Significance of serum magnesium levels in critically ill patients. Int J Applied Basic Med Res. 2014;4(1):34-7.

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.