Hypomagnesemia in Postoperative Spine Fusion Patients

Place, Howard M.; Enzenauer, Raymond J.; Muff, Barbara J.; Ziporin, Philip J.; Brown, Courtney W.

doi:10.1097/00007632-199610010-00018

Cited by 19 publications

(29 citation statements)

References 20 publications

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“…Embora a hipomagnesemia seja um dos distúrbios eletrolí-ticos mais comuns em pacientes hospitalizados, especialmente nos criticamente doentes 1,2 e no período pós-operatório 1 , é também considerado o distúrbio mais subdiagnosticado 3 . Ocorre em cerca de 11% dos pacientes hospitalizados; em 20% dos pacientes admitidos em Unidade de Terapia Intensiva (UTI); e em 61% dos pacientes admitidos em UTI cirúrgica 3 .…”

Section: Introductionunclassified

“…Ocorre em cerca de 11% dos pacientes hospitalizados; em 20% dos pacientes admitidos em Unidade de Terapia Intensiva (UTI); e em 61% dos pacientes admitidos em UTI cirúrgica 3 . É associado a hospitalização prolongada, com maior tempo de permanência em UTI e maior mortalidade, tanto em pacientes clínicos quanto cirúrgicos 1 .…”

Section: Introductionunclassified

“…Na literatura, há poucos relatos de pacientes ortopédicos com hipomagnesemia 1,3 , porém chama a atenção sua elevada frequência no pós-operatório de pacientes submetidos a cirurgias com grande envolvimento ósseo, como a artro-dese de coluna 1,3,4 . A etiologia da deficiência de magnésio, nesses casos, é descrita como multifatorial: associação com transfusão sanguínea (o citrato atua como quelante, com formação do citrato de magnésio) 1,3 dilucional, devido à administração de grandes quantidades de fluido hipotônico durante a cirurgia 1,3,4 ; e alteração transitória da função das paratireoides, consequente ao rompimento do periósteo e tecido ósseo 4 .…”

Section: Introductionunclassified

“…A etiologia da deficiência de magnésio, nesses casos, é descrita como multifatorial: associação com transfusão sanguínea (o citrato atua como quelante, com formação do citrato de magnésio) 1,3 dilucional, devido à administração de grandes quantidades de fluido hipotônico durante a cirurgia 1,3,4 ; e alteração transitória da função das paratireoides, consequente ao rompimento do periósteo e tecido ósseo 4 . Independente de sua etiologia, o paciente com hipomagnesemia pode apresentar, principalmente: arritmias atriais e ventriculares 2 , isquemia miocárdica 3,5 , insuficiência cardíaca 2 e alterações neurológicas, como crises convulsivas 2,4,6,7 e rebaixamento do nível de consciência 6 .…”

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Hypomagnesemia after spinal fusion

Chrun¹,

João²

2012

J Pediatr (Rio J)

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Objectives: To determine the frequency of hypomagnesaemia in pediatric patients after spinal fusion, to verify whether postoperative magnesium levels were lower than preoperative levels and, if so, to identify possible causes and assess the clinical repercussions for patients. Methods:This was a retrospective descriptive study of pediatric patients admitted to a pediatric intensive care unit (ICU) after spine fusion surgery, between March 1 and August 31, 2011. Preoperative magnesium, phosphorus and total and ionized calcium concentrations were compared with the results of tests conducted during the first 24 hours after admission to the ICU. Results:A total of 45 patients were enrolled on the study. Median age was 13.1 years. Preoperative mean serum magnesium was 1.8±0.2 mg/dL and postoperative serum magnesium was 1.4±0.2 mg/dL, which was a significant reduction between the two periods (p < 0.001). The frequency of hypomagnesaemia rose from 1 patient (2%) in the preoperative period to 31 patients (68%) during the postoperative period. There were also significant reductions in concentrations of phosphorus (p < 0.001) and total calcium (p < 0.001). There was a significant correlation between magnesium reductions and the volume of fluids administered during the surgery (p = 0.03), transfused blood volume (p < 0.001) and number of vertebrae fused (p < 0.05). Seven of the 31 patients with hypomagnesemia exhibited symptoms (22%). Conclusion:There was an elevated frequency of hypomagnesemia in patients who underwent spinal fusion. Serum magnesium should be assayed when patients are admitted to the pediatric ICU, so appropriate supplementation can be initiated immediately, minimizing the risk of complications.J Pediatr (Rio J). 2012;88(3):227-32: Hypomagnesemia, pediatric ICU, spine fusion. ResumoObjetivos: Verificar a frequência de hipomagnesemia em pacientes pediátricos submetidos a artrodese de coluna, avaliando se há queda significativa nas dosagens de magnésio sérico nos períodos pré e pós-operatório, quais suas possíveis causas e quais as consequências clínicas para os pacientes. Métodos:Estudo retrospectivo e descritivo dos pacientes admitidos em uma Unidade de Terapia Intensiva pediátrica no pós-operatório de artrodese de coluna, no período de 1º de março a 31 de agosto de 2011. Foram comparados os níveis de magnésio, fósforo, cálcio total e ionizado no pré-operatório com os valores encontrados após a admissão na Unidade de Terapia Intensiva. Resultados:Foram incluídos 45 pacientes, com idade média de 13,1 anos. No pré-operatório, o valor médio do magnésio foi de 1,8±0,2 mg/dL, e no pós-operatório, de 1,4±0,2 mg/dL, o que demonstra uma queda significativa entre os dois períodos (p < 0,001). A frequência de hipomagnesemia foi de somente um paciente (2%) no pré-operatório para 31 (68%) no pós-operatório. Houve também queda significativa nos níveis de fósforo (p < 0,001) e cálcio total (p < 0,001). Houve correlação significativa entre a queda do magnésio e o volume de fluido recebido durante a cirurgia (p =...

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Section: Introductionunclassified

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Hypomagnesemia after spinal fusion

Chrun¹,

João²

2012

J Pediatr (Rio J)

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“…The present study reveals hypomagnesemia is prevalent both pre-operatively(35%) and post-operatively(64%) in a significant proportion of patients undergoing surgery for gynecological cancer. 4,10,11 Even falling levels of serum magnesium in post-operative period has a bearing on the final surgical outcome. Falling serum magnesium levels indicate the magnitude of surgical stress which has a positive impact on post-operative complications.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of hypomagnesemia in patients undergoing gynecological oncology surgery in tertiary care cancer institute of India

Bhardwaj¹,

Desai

Patel

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONMagnesium is the second most abundant element inside human cells and the fourth most abundant positively charged ion in the human body. Magnesium is crucial to more than 300 enzyme driven biochemical reactions in the body on a near constant basis. 1Magnesium is one of the most common co-factors in the body. Its presence is crucial to ABSTRACT Background: Hypomagnesemia is an important but unknown risk factor for post-operative complications in patients undergoing surgery for presumed gynecological malignancy. This study aims to evaluate the prevalence of hypomagnesemia in patients undergoing surgery for presumed gynecological cancers referred to our tertiary care Cancer Institute. Methods: This is a prospective observational study of 100 patients admitted with provisional diagnosis of malignancy. They underwent surgery in one of the Gynecologic Oncology units at The Gujarat Cancer Research Institute, Ahmedabad from October 2016 to April 2017. Hypomagnesemia was defined a serum magnesium levels less than 1.8mg/dl. Results: The incidence of pre-operative hypomagnesemia in the entire cohort was 35%. Sixty three percent patients had normal pre-operative magnesium levels and hypermagnesemia was seen in 2% of study population. Patients with benign disease had 29.6% pre-operative hypomagnesemia compared with 39.6% in patients with gynecologic malignancy. Pre-operative hypomagnesemia and even falling levels in post-operative period are an important predictive marker for post-operative complications like increased post-operative pain, post-operative ileus, hypertension and even post-operative hypokalemia. Age, body mass index, hematocrit, surgical indication and length of hospital stay were not associated with hypomagnesemia. Patients undergoing neo-adjuvant chemotherapy before surgery had significant incidence of hypomagnesemia both pre-operatively and post-operatively. Conclusions: Hypomagnesemia is quite prevalent in patients of gynecologic-oncology undergoing surgery. Preoperative hypomagnesemia and even falling levels in post-operative period have a bearing on the final surgical outcome. Hence pre-operative and post-operative magnesium levels may be included as a valuable marker in all patients undergoing surgery for gynecologic malignancy.

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