Volume 5 Supplement 1

21st International Symposium on Intensive Care and Emergency Medicine

Open Access

Magnesium in the intensive care unit

  • A Abraham1,
  • A Bachwani1,
  • DM Gamadia1,
  • BB Ichhaporia1,
  • P Singer2 and
  • J Cohen2
Critical Care20015(Suppl 1):P207

DOI: 10.1186/cc1274

Received: 15 January 2001

Published: 2 March 2001

Introduction and aims

Magnesium has been used since time immemorial as a purgative and uterine relaxant. Magnesium regulates many life processes and is the key factor in the production of ATP, the source of life energy. It is a natural calcium channel blocker and neutralizes the effect of catecholamines, it works very well on supraventricular and ventricular arrhythmias. We obtained excellent results on cardiac arrhythmias and drug induced supraventricular tachycardia (dopamine, dobutamine, noradrenaline, adrenaline and aminophylline). The aim of this prospective study is to know the affects of magnesium therapy on different critical conditions in the ICU.

Methods

Administer magnesium 5 g in D5W over 6–8 hours. The heart rate is monitored at 15, 30, 45, 60, 75 and 90 min, and then at 6 and 12-hour interval. To give the same dose for 5 consecutive days. Other parameters like urine output, creatinine and patient's survival were noted.

Results

Prospective study: 115 cases treated with magnesium (50 drug induced SVT, 20 SVT, 5 ARDS, 16 CCF, 7 CPR, 7 Diabetic ketoacidosis, 1 carpopedal spasm, 1 chronic alcoholism induced hypokalemia).

Benefits seen after magnesium therapy

1. Heart rate came down within an avg of 45 min, rhythm improved from irregular to regular and to good volume. 2. Urine output increased from almost oliguria to 30–40 ml/hour. Creatinine reduced or did not rise any further. 3. Pulmonary edema resolved in 24 hours. 4. Lactic acidosis disappeared with in 4–5 hours.

Discussions

1. Tachycardia induced by positive inotropes or cardiac pathology comes down to an acceptable rate when Magnesium is given in an average of 45 min. 2. Patients are protected from Tachyarrhythmia (Atrial and Ventricular arrhythmia). Incidences of drug-induced arrhythmias when Magnesium is given concomitantly with inotropes or bronchodilators are nil. 3.

Magnesium improves energy production (ATP) and stimulates metabolism. This is advantageous as patients requiring ionotropes are always in shock. 4. The affect of Magnesium therapy on Base Deficit (Lactic Acidosis) is to be studied further, because we got normal base values within 5–6 hours of Magnesium.
https://static-content.springer.com/image/art%3A10.1186%2Fcc1274/MediaObjects/13054_2001_Article_1315_Fig1_HTML.jpg
Figure

Graphical presentation (average heart rate).

https://static-content.springer.com/image/art%3A10.1186%2Fcc1274/MediaObjects/13054_2001_Article_1315_Fig2_HTML.jpg
Figure

Serum creatinine (after Mg therapy over 5 days).

Table

Results after the use of magnesium in patients having different pathology

Pathology

No of patients

Heart rate

Urine output

Creatinine

Died

Survived

Drug induced

50

164–108/min

Improved

Not studied

Not studied

Not studied

SVT

20

180–84/min (45 min)

Improved

Normal

0

20

ARDS

5

130–84/min

Improved

Reduced

3

2

CCF

16

144–102/min

Improved

7–1

8

8

CPR

7

Vent. Tach. – normal rhythm

Improved (later on)

Not studied

2

5

Diabetic ketoacidosis

7

150–96/min

Improved

Reduced (N)

2

5

Carpopedal spasm

1

NA

NA

 

0

1

Alcoholic hypokalemia

1

Bradycardia (corrected)

  

0

1

Base deficit

9

Came to normal in 4–5 hours

0

9

Table

Inotropes (dopamine, dobutamine & noradrenaline) induced SVT after the use of magnesium

0 min

15 min

30 min

45 min

60 min

75 min

90 min

6 hours

12 hours

164

138

129

108

101

100

96

92

94

In 45 min, the average heart rate comes down to 108.

Authors’ Affiliations

(1)
Intensive Care Unit, Parsee General Hospital
(2)
General Intensive Care Unit, Beilinson Hospital

Copyright

© The Author(s) 2001