Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana

BMC Anesthesiology

R. Djagbletey²  F. Boni²  B. Phillips²  Y. Adu-Gyamfi²  E. Aniteye²  C. Owoo²  E. Owusu-Darkwa²  A. E. Yawson¹ 

[1] Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana

[2] Department of Anaesthesia, University of Ghana School of Medicine and Dentistry, College of Health Sciences, Accra, Ghana

关键词: Predictive factors;    Laparotomy;    Patients;    Adult surgical;    Serum albumin;    Serum potassium;    Serum magnesium;    Preoperative;   

Others  :  1229669
DOI  :  10.1186/s12871-015-0116-7

 received in 2015-07-02, accepted in 2015-09-28,  发布年份 2015

【 摘 要 】

Background

Magnesium is the second most abundant intracellular cation and a co-factor in several reactions involved in the formation and usage of adenosine triphosphate and nucleic acid synthesis. Magnesium deficiency may be as high as 65 % in patients admitted to a medical Intensive Care Unit (ICU). Significant and potentially fatal conditions have been attributed to hypomagnesaemia and it has also been associated with poor prognosis and increased mortality in the critically ill. The study aimed to determine the prevalence and identify the predictive factors of preoperative hypomagnesaemia in adult surgical patients who require an emergency laparotomy.

Methods

This was a hospital based prospective study conducted at the Korle-Bu teaching hospital. General surgical patients between the ages of eighteen and seventy years with a preoperative diagnosis which required emergency laparotomy for management were consecutively enrolled into the study. A total of 102 patients were enrolled in the study. Preoperative total serum magnesium and serum potassium were determined.

Data was summarised utilising simple descriptive statistics (i.e., proportions, ratios and percentages). The Chi-square test was used to determine significant differences or associations between categorical variables, Pearson’s correlation coefficient was used to determine the relationship between continuous variables and predictive factors were determined by multiple regression. Analysis was done in SPSS version 16.

Results

The mean serum total magnesium and potassium were 0.66 ± 0.20 mmol/L and 3.79 ± 0.65 mmol/L respectively. The prevalence of preoperative hypomagnesaemia was found to be 68.0 %. Multiple logistic regression found only hypokalaemia to be a predictive factor (p-value of 0.001, odd’s ratio of 9.21 and a confidence interval of 2.42–35.09).

Conclusion

The prevalence of preoperative hypomagnesaemia was high (68.0 %) with hypokalaemia the only predictive factor. Hypokalaemic patients requiring emergency laparotomy are nine times more likely to develop hypomagnesaemia as compared to patients who were not hypokalaemic.

【 授权许可】

   
2015 Djagbletey et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Swaminathan R. Magnesium Metabolism and its Disorders. Clin Biochem Rev. 2003; 24(2):47-66.
• [2]Whang R, Oei TO, Aikawa JK, Watanabe A, Vannatta J, Fryer A et al.. Predictors of Clinical Hypomagnesemia. Arch Intern Med. 1984; 144(9):1794-6.
• [3]Ryzen E, Wagers PW, Singer FRRR. Magnesium homeostasis in critically ill patients. Magnesium. 1989; 8(3–4):201-12.
• [4]Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med. 1993; 21:203-9.
• [5]Safavi MHA. ADMISSION HYPOMAGNESEMIA - Impact on Mortality or Morbidity in critically ill patients. Middle East J Anesth. 2007; 19(3):645-60.
• [6]Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999; 83(2):302-20.
• [7]Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr. 2003; 133(9):2879-82.
• [8]Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012; 5 Suppl 1:i3-14.
• [9]Seo JW, Park TJ. Magnesium Metabolism. Electrolyte Blood Press. 2008; 6(2):86-95.
• [10]James MFM. Magnesium: an emerging drug in anaesthesia. Br J Anaesth. 2009; 103(4):465-7.
• [11]Tietz Fundamentals of Clinical Chemistry. 5th ed. W.B. Saunders, Philadehilpa; 2001.
• [12]Chernow B, Bamberger S, Stoiko M, Vadnais M, Mills S, Hoellerich VWA. Hypomagnesemia in patients in postoperative intensive care. Chest. 1989; 95(2):391.
• [13]Adensunkanni AR, Desunkan MIAO. The prognostic factors in typhoid ileal perforation: a prospective study of 50 patients. J R Coll Surg Edin. 1997; 42:395-9.
• [14]Adamu A, Maigatari M, Lawal K, Iliyasu M. Waiting time for emergency abdominal surgery in Zaria. Nigeria. 2010; 10(1):46-53.
• [15]Vitamins and minerals in human nutrition. 2004.
• [16]Deheinzelin D, Negri EM, Tucci MR, Salem MZ, da Cruz VM, Oliveira RM et al.. Hypomagnesemia in critically ill cancer patients : a prospective study of predictive factors. Braz J Med Biol Res. 2000; 33:1443-8.
• [17]Huijgen HJ, Soesan M, Sanders R, Mairuhu WM, Kesecioglu J, Sanders GT. Magnesium Levels in Critically Ill Patients What Should We Measure ? Am J Clin Pathol. 2000; 114(5):688-95.
• [18]Szpetnar M, Matras P, Boguszewska-czubara A, Rudzki S. Magnesiun in patients operated due to colorectal or small intestine cancer and receiving total parentral nutrition (TPN) in postoerative period. J Elementol. 2011; 16(1):125-34.
• [19]Ohene-Yeboah M. Acute surgical admissions for abdominal pain in adults in Kumasi, Ghana. ANZ J Surg. 2006; 76(10):898-903.
• [20]Limaye CS, Londhey V, Nadkar MYBN. Hypomagnesemia in Critically Ill Medical Patients. J Assoc Physicians India. 2011; 59(1):19-22.
• [21]Flink EB. Magnesium Deficiency. Etiology and Clinical Spectrum. Acta Med Scand. 1981; 209:125-37.
• [22]Konrad M. Insights into the molecular nature of magnesium homeostasis. AJP Ren Physiol. 2004; 286(4):599F-605.
• [23]Touyz RM. Magnesium in clinical medicine. Front Biosci. 2004; 9:1278-93.
• [24]Elin RJ. Magnesium: the fifth but forgotten electrolyte. Am J Clin Pathol. 1994; 102(5):616-22.