Ari Moskowitz1, Joon Lee2, Michael W Donnino3, Roger Mark4, Leo Anthony Celi5, John Danziger6. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA amoskowi@bidmc.harvard.edu. 2. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 3. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 4. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. 5. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 6. Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
INTRODUCTION: Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined. METHODS: This was a retrospective, cross-sectional study conducted at a 77 ICU bed tertiary medical center. Data pertaining to the first unique admission of any ICU patient between 2001 and 2008 were extracted from the Multiparameter Intelligent Monitoring in Intensive Care database. Hypomagnesemia was defined as serum magnesium <1.6 mg/dL. Mild and severe lactic acidosis were defined as lactate concentrations of >2 and > 4 mmol/L, respectively. Multivariate modeling was used to explore the association between magnesium and lactate concentrations. RESULTS: Of 8922 critically ill patients, 22.6% were hypomagnesemic. Hypomagnesemia was associated with an increased adjusted risk of mild lactic acidosis (odds ratio [OR] 1.71, 95% confidence interval [95%CI] 1.51-1.94, P < .001) and severe lactic acidosis (OR 1.56, 95%CI 1.32-1.84, P < .001) than the reference quartile. The association between hypomagnesemia and mild lactic acidosis was stronger in those at risk of magnesium deficiency, including diabetics (OR 2.02, 95%CI 1.51-2.72, P < .001) and alcoholics (OR 1.92, 95%CI 1.16-3.19, P = .01). As an internal model control, hypokalemia was not associated with an increased risk of lactic acidosis. CONCLUSIONS: Magnesium deficiency is a common finding in patients admitted to the ICU and is associated with lactic acidosis. Our findings support the biologic role of magnesium in metabolism and raise the possibility that hypomagnesemia is a correctable risk factor for lactic acidosis in critical illness.
INTRODUCTION: Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined. METHODS: This was a retrospective, cross-sectional study conducted at a 77 ICU bed tertiary medical center. Data pertaining to the first unique admission of any ICU patient between 2001 and 2008 were extracted from the Multiparameter Intelligent Monitoring in Intensive Care database. Hypomagnesemia was defined as serum magnesium <1.6 mg/dL. Mild and severe lactic acidosis were defined as lactate concentrations of >2 and > 4 mmol/L, respectively. Multivariate modeling was used to explore the association between magnesium and lactate concentrations. RESULTS: Of 8922 critically ill patients, 22.6% were hypomagnesemic. Hypomagnesemia was associated with an increased adjusted risk of mild lactic acidosis (odds ratio [OR] 1.71, 95% confidence interval [95%CI] 1.51-1.94, P < .001) and severe lactic acidosis (OR 1.56, 95%CI 1.32-1.84, P < .001) than the reference quartile. The association between hypomagnesemia and mild lactic acidosis was stronger in those at risk of magnesium deficiency, including diabetics (OR 2.02, 95%CI 1.51-2.72, P < .001) and alcoholics (OR 1.92, 95%CI 1.16-3.19, P = .01). As an internal model control, hypokalemia was not associated with an increased risk of lactic acidosis. CONCLUSIONS:Magnesium deficiency is a common finding in patients admitted to the ICU and is associated with lactic acidosis. Our findings support the biologic role of magnesium in metabolism and raise the possibility that hypomagnesemia is a correctable risk factor for lactic acidosis in critical illness.
Authors: Maria Paz Escuela; Manuel Guerra; José M Añón; Vicente Martínez-Vizcaíno; María Dolores Zapatero; Angel García-Jalón; Sebastian Celaya Journal: Intensive Care Med Date: 2004-12-17 Impact factor: 17.440
Authors: Donogh Maguire; Alana Burns; Dinesh Talwar; Anthony Catchpole; Fiona Stefanowicz; David P Ross; Peter Galloway; Alastair Ireland; Gordon Robson; Michael Adamson; Lesley Orr; Joanna-Lee Kerr; Xenofon Roussis; Eoghan Colgan; Ewan Forrest; David Young; Donald C McMillan Journal: Sci Rep Date: 2022-04-28 Impact factor: 4.996