The Association Between Admission Magnesium Concentrations and Lactic Acidosis in Critical Illness

Moskowitz, Ari; Lee, Joon; Donnino, Michael W.; Mark, Roger G.; Celi, Leo Anthony; Danziger, John

doi:10.1177/0885066614530659

Cited by 29 publications

(28 citation statements)

References 41 publications

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“…Similar to previous researches, our findings indicate that hypomagnesemia is a risk factor for a shift from aerobic metabolism to anaerobic metabolism and an increase in lactate production [26]. As mentioned previously, magnesium deficiency can increase inflammation and impaire aerobic metablism of glucose which may be an explanation for increase in lactate production.…”

Section: Discussionsupporting

confidence: 91%

“…Energy metabolism, protein and nucleic acids synthesis and effects on Hypomagnesemia is a common electrolyte disorder among ICU patients with sepsis and observational studies showed that it is significantly associated with poor clinical outcomes. Previous studies on critically ill patients in ICU, reported different prevalence of admission hypomagnesemia varying from 20% to 65% [12,19,[26][27][28][29][30]. In this study population, 36% of patients had hypomagnesemia at admission to ICU.…”

Section: Discussionmentioning

confidence: 68%

“…Increase in lactic acid production due to magnesium deficiency, occurs because of a shift to anaerobic metabolism from oxidative phosphorylation in mitochondria [25]. In a study by Moskowitz et al, magnesium deficiency was described as a risk factor for lactate production in critically ill patients [26]. In this study, we aimed to evaluate the association between serum magnesium and lactate level in sepsis patient.…”

mentioning

confidence: 93%

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Correlation between Serum Magnesium and Lactate Levels at the Time of ICU Admission and Early Phase of Sepsis

Assarian¹,

Noormandi²,

Khalili³

et al. 2019

AACC

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Background: As the fourth abundant electrolyte in the body, magnesium has critical roles in aerobic metabolism and regulation of the immune system. Few studies investigate the association between magnesium status of critically ill septic patients and lactate acidosis in the intensive care unit (ICU). In this study, serum magnesium level and lactate level were evaluated at both admission time and time of sepsis. Methods: This was a prospective, cross-sectional study conducted at general ICU of a tertiary referral teaching hospital. Hypomagnesemia was defined as a serum magnesium concentration of less than 1.7 mg/dL. Mann-Whitney test and independent-sample t-test were used to analyze nonparametric and parametric data, respectively. Results: Of 50 sepsis patients, 32 patients were normomagnesemic, and 18 were hypomagnesemic. Hypomagnesemic patients have significantly higher lactate serum level at the time of sepsis compared to normomagnesemic patients [2.32 (1.96-3.29) vs. 1.94 (1.80-2.15) mg/dl respectively, p<0.001]. There were significant differences between normomagnesemic and hypomagnesemic septic patients in Acute Physiology and Chronic Health Evaluation (APACHE) II score at sepsis time (9.44 ± 4.33 vs. 11.67 ± 3.83, p=0.46), and Sequential Organ Failure Assessment (SOFA) score [3 (3.00-5.00) vs. 4 (3.75-6.25), p=0.04]. Also, 28-day mortality because of sepsis (50% respectively, p<0.001), duration of mechanical ventilation [12.00 (4.00-14.25) days respectively, p<0.01] and ICU stay [14.00 (12.75-17.25) days respectively, p<0.01] were significantly higher in hypomagnesemic groups. Conclusion: Admission hypomagnesemia in sepsis patients may increase serum lactate concentration, duration of ventilation, duration of ICU stay and mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 68%

mentioning

confidence: 93%

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Correlation between Serum Magnesium and Lactate Levels at the Time of ICU Admission and Early Phase of Sepsis

Assarian¹,

Noormandi²,

Khalili³

et al. 2019

AACC

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“…In this study, hypomagnesemia was present in 22.6% of patients, and was associated with lactic acidosis. The authors suggested that low plasma Mg level is a correctable risk factor for lactic acidosis in critical illness [ 19 ].…”

Section: Literature Search Resultsmentioning

confidence: 99%

Hypomagnesemia in Critically Ill Sepsis Patients

et al. 2015

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Magnesium (Mg), also known as “the forgotten electrolyte”, is the fourth most abundant cation overall and the second most abundant intracellular cation in the body. Mg deficiency has been implicated in the pathophysiology of many diseases. This article is a review of the literature regarding Mg abnormalities with emphasis on the implications of hypomagnesemia in critical illness and on treatment options for hypomagnesemia in critically ill patients with sepsis. Hypomagnesemia is common in critically ill patients, and there is strong, consistent clinical evidence, largely from observational studies, showing that hypomagnesemia is significantly associated with increased need for mechanical ventilation, prolonged ICU stay and increased mortality. Although the mechanism linking hypomagnesemia with poor clinical outcomes is not known, experimental data suggest mechanisms contributing to such outcomes. However, at the present time, there is no clear evidence that magnesium supplementation improves outcomes in critically ill patients with hypomagnesemia. Large, well-designed clinical trials are needed to evaluate the role of magnesium therapy for improving outcomes in critically ill patients with sepsis.

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“…However, as far as we know, few studies have focused on lactate dynamics. Moskowitz et al [17] showed that hypo-magnesium (<1.6 mg/dL) was associated with an increased risk of mild (>2 mmol/L) and severe (>4 mmol/L) lactic acidosis in 8,922 critically ill patients extracted from the MIMIC II database. Using a fractional polynomial Cox-proportional hazard model, Zhang et al [18] reported that higher initial lactate concentration and longer lactate normalization time were significantly associated with increased hazard of mortality in 6,291 ICU patients from the MIMIC II database.…”

Section: Mimic Database and Lactate Studymentioning

confidence: 99%

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

et al. 2020

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BackgroundWe performed an exclusive study to investigate the associations between a total of 23 lactate-related indices during the first 24h in an intensive care unit (ICU) and in-hospital mortality. MethodsNine static and 14 dynamic lactate indices, including changes in lactate concentrations (Δ Lac) and slope (linear regression coefficient), were calculated from individual critically ill patient data extracted from the Multiparameter Intelligent Monitoring for Intensive Care (MIMIC) III database. ResultsData from a total of 781 ICU patients were extracted, consisted of 523 survivors and 258 non-survivors. The in-hospital mortality rate for this cohort was 33.0%. A multivariate logistic regression model identified maximal lactate concentration at 24h after ICU admission (max lactate at T24) as a significant predictor of in-hospital mortality (odds ratio = 1.431, 95% confidence interval [CI] = 1.278-1.604, p<0.001) after adjusting for predefined confounders (age, gender, sepsis, Elixhauser comorbidity score, mechanical ventilation, renal replacement therapy, vasopressors, ICU severity scores). Area under curve (AUC) for max lactate at T24 was larger (AUC = 0.776, 95% CI = 0.740-0.812) than other indices (p<0.001), comparable to an APACHE III score of 0.771. When combining max lactate at T24 with APACHE III, the AUC was increased to 0.815 (95% CI:0.783-0.847). The sensitivity, specificity, and positive and negative predictive values for the cut-off value of 3.05 mmol/L were 64.3%, 77.4%, 58.5%, and 81.5%, respectively.Kaplan-Myer survival curves of the max lactate at T24 for 90-day survival after admission to ICU demonstrated a significant difference according to the cut-off value (p<0.001). ConclusionsThese data indicate that the maximal arterial lactate concentration at T24 is a robust predictor of in-hospital mortality as well as 90-day survival in unselected ICU patients with predictive ability as comparable with APACHE III score.

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The Association Between Admission Magnesium Concentrations and Lactic Acidosis in Critical Illness

Cited by 29 publications

References 41 publications

Correlation between Serum Magnesium and Lactate Levels at the Time of ICU Admission and Early Phase of Sepsis

Correlation between Serum Magnesium and Lactate Levels at the Time of ICU Admission and Early Phase of Sepsis

Hypomagnesemia in Critically Ill Sepsis Patients

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

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