MAGNESIUM IN INTENSIVE CARE UNIT HYPOMAGNESEMIA , HYPERMAGNESEMIA & THERAPEUTIC USES
AbdulRahman Nasser Ali;
Abstract
Magnesium is the second-most abundant intracellular cation and, overall, the fourth-most abundant cation. It plays a fundamental role in many functions of the cell, including energy transfer, storage, and use; protein, carbohydrate, and fat metabolism; maintenance of normal cell membrane function; and the regulation of parathyroid hormone (PTH) secretion. Systemically, magnesium lowers blood pressure and alters peripheral vascular resistance.
Magnesium deficiency has been reported in 20 to 65% of patients in the ICU. Reduction in serum total magnesium on admission to the ICU has been shown to be associated with increased morbidity and mortality.
Hypomagnesemia may be due to decreased intake, redistribution of magnesium from extracellular to intracellular space (e.g: Hungry bone syndrome, insulin and acute pancreatitis), gastrointestinal magnesium loss (e.g: vomiting, diarrhea and proton pump inhibitors), renal magnesium loss (e.g: gitelman syndrome and inherited renal tubular defects).
Hypomagnesemia may be asymptomatic and may manifest in sever conditions in the form of muscle weakness , tremors, seizure, paresthesias, tetany, positive Chvostek sign and Trousseau sign, ECG changes arrhythmias and syncope.
Hypomagnesemia is treated by treatment of the cause and magnesium supplementation .
Hypermagnesemia is rare. It is mainly caused by renal failure . Clinically present by vomiting, disturbed conscious level, complete heart block, and death in severe cases. Electrocardiogram during hypermagnesemia and hypocalcemia have shown a prolonged QT interval and atrioventricular block. Hypermagnesemia is treated by intravenous administration of low doses of Ca2+ may quickly reduce the severity of symptoms due to the antagonistic effect of Ca2+ on Mg2+. In addition, haemodialysis may be used to quickly reduce serum Mg2+ levels in severe cases. Furosemide may promote excretion of magnesium. Agents that shift magnesium ions into cells are helpful in treating hypermagnesemia. Glucose and insulin may help promote magnesium entry into cells.
Studies have shown the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Other areas that have shown promising results include lowering the risk of metabolic syndrome, improving glucose and insulin metabolism, relieving symptoms of dysmenorrhea, and alleviating leg cramps in women who are pregnant. The use of magnesium for constipation and dyspepsia are accepted as standard care despite limited evidence. Although it is safe in selected patients at appropriate dosages, magnesium may cause adverse effects or death at high dosages. Because magnesium is excreted renally, it should be used with caution in patients with kidney disease.
Magnesium deficiency has been reported in 20 to 65% of patients in the ICU. Reduction in serum total magnesium on admission to the ICU has been shown to be associated with increased morbidity and mortality.
Hypomagnesemia may be due to decreased intake, redistribution of magnesium from extracellular to intracellular space (e.g: Hungry bone syndrome, insulin and acute pancreatitis), gastrointestinal magnesium loss (e.g: vomiting, diarrhea and proton pump inhibitors), renal magnesium loss (e.g: gitelman syndrome and inherited renal tubular defects).
Hypomagnesemia may be asymptomatic and may manifest in sever conditions in the form of muscle weakness , tremors, seizure, paresthesias, tetany, positive Chvostek sign and Trousseau sign, ECG changes arrhythmias and syncope.
Hypomagnesemia is treated by treatment of the cause and magnesium supplementation .
Hypermagnesemia is rare. It is mainly caused by renal failure . Clinically present by vomiting, disturbed conscious level, complete heart block, and death in severe cases. Electrocardiogram during hypermagnesemia and hypocalcemia have shown a prolonged QT interval and atrioventricular block. Hypermagnesemia is treated by intravenous administration of low doses of Ca2+ may quickly reduce the severity of symptoms due to the antagonistic effect of Ca2+ on Mg2+. In addition, haemodialysis may be used to quickly reduce serum Mg2+ levels in severe cases. Furosemide may promote excretion of magnesium. Agents that shift magnesium ions into cells are helpful in treating hypermagnesemia. Glucose and insulin may help promote magnesium entry into cells.
Studies have shown the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Other areas that have shown promising results include lowering the risk of metabolic syndrome, improving glucose and insulin metabolism, relieving symptoms of dysmenorrhea, and alleviating leg cramps in women who are pregnant. The use of magnesium for constipation and dyspepsia are accepted as standard care despite limited evidence. Although it is safe in selected patients at appropriate dosages, magnesium may cause adverse effects or death at high dosages. Because magnesium is excreted renally, it should be used with caution in patients with kidney disease.
Other data
| Title | MAGNESIUM IN INTENSIVE CARE UNIT HYPOMAGNESEMIA , HYPERMAGNESEMIA & THERAPEUTIC USES | Other Titles | اضطرابات المغنسيوم بالرعاية المركزة زيادته و نقصانه و استخداماته العلاجية | Authors | AbdulRahman Nasser Ali | Issue Date | 2015 |
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