Serum magnesium increases following severe hemorrhage in dogs blocked by verapamil treatment

Alterations of Mg2+ After Hemorrhagic Shock

Hemorrhagic shock is generally characterized by hemodynamic instability with cellular hypoxia and diminishing cellular function, resulting from an imbalance between systemic oxygen delivery and consumption and redistribution of fluid and electrolytes. Magnesium (Mg) is the fourth most abundant cation overall and second most abundant intracellular cation in the body and an essential cofactor for the energy production and cellular metabolism. Data for blood total Mg (tMg; free-ionized, protein-bound, and anion-bound forms) and free Mg²⁺ levels after a traumatic injury are inconsistent and only limited information is available on hemorrhagic effects on free Mg²⁺ as the physiologically active form. The aim of this study was to determine changes in blood Mg²⁺ and tMg after hemorrhage in rats identifying mechanism and origin of the changes in blood Mg²⁺. Hemorrhagic shock produced significant increases in blood Mg²⁺, plasma tMg, Na⁺, K⁺, Cl^-, anion gap, partial pressures of oxygen, glucose, and blood urea nitrogen but significant decreases in RBC tMg, blood Ca²⁺, HCO₃^-, pH, partial pressures of carbon dioxide, hematocrit, hemoglobin, total cholesterol, and plasma/RBC ATP. During hemorrhagic shock, K⁺, anion gap, and BUN showed significant positive correlations with changes in blood Mg²⁺ level, while Ca²⁺, pH, and T-CHO correlated to Mg²⁺ in a negative manner. In conclusion, hemorrhagic shock induced an increase in both blood-free Mg²⁺ and tMg, resulted from Mg²⁺ efflux from metabolic damaged cell with acidosis and ATP depletion.

The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients

BACKGROUND

We hypothesized that lactate dehydrogenase, LDH/albumin ratio in combination with or without magnesium (Mg(2+)) could predict organ failure in critically ill adult patients. The aim of this study was to describe a new risk index for organ failure or mortality in critically ill patients based on a combination of these routinely available biochemical plasma biomarkers.

METHODS

Patients ≥ 18 years admitted to the intensive care unit (ICU) were screened. Albumin and LDH were analyzed at the time of admission to ICU (n = 347). Organ failure assessed with 'Sequential Organ Failure Assessment' (SOFA) score was used, and 30-day mortality was recorded. The predictive value of the test was calculated using the areas under the receiving operating characteristic (ROC) curve.

RESULTS

The LDH/albumin ratio was higher in patients who developed organ failure as compared to those who did not (p < 0.001). The areas under the ROC curve were 0.77 both for prediction of multiple organ failure and for 30-day mortality. In a subgroup of patients (n = 183) admitted to ICU from the emergency department, the predictive values were 0.86 and 0.80, respectively.

CONCLUSION

The LDH/albumin ratio at ICU admission was associated with the development of multiple organ failure and 30-day mortality in this prospective study. The clinical value of this biomarker as a predictor of organ failure in critically ill patients is yet to be defined.