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Airagnes G, Valter R, Ducoutumany G, Vansteene C, Trabut JB, Gorwood P, Dubertret C, Matta J, Charles-Nelson A, Limosin F. Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial. Alcohol Alcohol 2023; 58:329-335. [PMID: 37012631 DOI: 10.1093/alcalc/agad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE Alcohol withdrawal syndrome (AWS) is a frequent and potentially life-threatening condition experienced in alcohol use disorder. Since hypomagnesemia is involved in AWS's severity, we conducted a multicenter double-blind randomized placebo-controlled trial to examine the efficacy of oral magnesium supplementation as an adjuvant therapy of AWS. MATERIAL AND METHODS Inpatients were recruited in six different centers if they had a baseline score higher than eight on the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). The experimental treatment was magnesium lactate dehydrate, administrated three times per day providing a total of 426.6 mg per day and up to 15 days. The primary endpoint was the significant between-group difference of the CIWA-Ar total score change from baseline to 3 days later. The treatment group and baseline score were introduced as covariables in an analysis of covariance. RESULTS A total of 98 inpatients were included {71.4% of men; mean age of 49.1 years [standard deviation (SD): 10.3]}. In the intention-to-treat population, the mean reduction of the CIWA-Ar score in the experimental group between baseline and 3 days later was 10.1 (SD: 5.2), whereas it was 9.2 (SD: 3.9) in the control group. The absolute difference of the adjusted mean in the experimental group compared with the control group was -0.69 (SD: 0.72), which did not correspond to a significant between-group difference (P = 0.34). Per-protocol analysis and sensitivity analyses also supported this result. Supplementary analyses found no significant difference regarding benzodiazepine consumption, magnesium blood concentration, and satisfaction to care. CONCLUSIONS The present study does not support the rationale of systematic oral magnesium supplementation in patients with AWS.
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Affiliation(s)
- Guillaume Airagnes
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- INSERM UMS011, Population-based Epidemiological Cohorts, Hôpital Paul Brousse Bât. 15/16, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France
| | - Rémi Valter
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - Géraldine Ducoutumany
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - Clément Vansteene
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France
| | - Jean-Baptiste Trabut
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Hôpital Emile ROUX, Department of Addictology, 1 Avenue de Verdun, 94450 Limeil-Brévannes, France
| | - Philip Gorwood
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
| | - Caroline Dubertret
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, University Hospital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France
| | - Joane Matta
- INSERM UMS011, Population-based Epidemiological Cohorts, Hôpital Paul Brousse Bât. 15/16, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France
| | - Anais Charles-Nelson
- INSERM, Centre d'Investigation Clinique 1418 Épidémiologie Clinique, AP-HP, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, 20 rue Leblanc, 75015 Paris, France
| | - Frédéric Limosin
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
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Maguire D, Burns A, Talwar D, Catchpole A, Stefanowicz F, Ross DP, Galloway P, Ireland A, Robson G, Adamson M, Orr L, Kerr JL, Roussis X, Colgan E, Forrest E, Young D, McMillan DC. Randomised trial of intravenous thiamine and/or magnesium sulphate administration on erythrocyte transketolase activity, lactate concentrations and alcohol withdrawal scores. Sci Rep 2022; 12:6941. [PMID: 35484175 PMCID: PMC9051209 DOI: 10.1038/s41598-022-10970-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Alcohol withdrawal syndrome (AWS) occurs in 2% of patients admitted to U.K. hospitals. Routine treatment includes thiamine and benzodiazepines. Laboratory studies indicate that thiamine requires magnesium for optimal activity, however this has not translated into clinical practice. Patients experiencing AWS were randomized to three groups: (group 1) thiamine, (group 2) thiamine plus MgSO4 or (group 3) MgSO4. Pre- and 2-h post-treatment blood samples were taken. AWS severity was recorded using the Glasgow Modified Alcohol Withdrawal Score (GMAWS). The primary outcome measure was 15% change in erythrocyte transketolase activity (ETKA) in group 3. Secondary outcome measures were change in plasma lactate concentrations and time to GMAWS = 0. 127 patients were recruited, 115 patients were included in the intention-to-treat analysis. Pre-treatment, the majority of patients had normal or high erythrocyte thiamine diphosphate (TDP) concentrations (≥ 275–675/> 675 ng/gHb respectively) (99%), low serum magnesium concentrations (< 0.75 mmol/L) (59%), and high plasma lactate concentrations (> 2 mmol/L) (67%). Basal ETKA did not change significantly in groups 1, 2 or 3. Magnesium deficient patients (< 0.75 mmol/L) demonstrated less correlation between pre-treatment basal ETKA and TDP concentrations than normomagnesemic patients (R2 = 0.053 and R2 = 0.236). Median plasma lactate concentrations normalized (≤ 2.0 mmol/L) across all three groups (p < 0.001 for all groups), but not among magnesium deficient patients in group 1 (n = 22). The median time to achieve GMAWS = 0 for groups 1, 2 and 3 was 10, 5.5 and 6 h respectively (p < 0.001).
No significant difference was found between groups for the primary endpoint of change in ETKA. Co-administration of thiamine and magnesium resulted in more consistent normalization of plasma lactate concentrations and reduced duration to achieve initial resolution of AWS symptoms. ClinicalTrials.gov: NCT03466528.
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Affiliation(s)
- Donogh Maguire
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK. .,Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Alana Burns
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Govan, G51 4TF, UK
| | - Dinesh Talwar
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Anthony Catchpole
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Fiona Stefanowicz
- The Scottish Trace Element and Micronutrient Diagnostic Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, UK
| | - David P Ross
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Peter Galloway
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Govan, G51 4TF, UK
| | - Alastair Ireland
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Gordon Robson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Michael Adamson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Lesley Orr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Joanna-Lee Kerr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Xenofon Roussis
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Eoghan Colgan
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Ewan Forrest
- Department of Gastroenterology and Hepatology, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Richmond Street, Glasgow, G1 1XH, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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Magnesium Status and Calcium/Magnesium Ratios in a Series of Cystic Fibrosis Patients. Nutrients 2022; 14:nu14091793. [PMID: 35565764 PMCID: PMC9104329 DOI: 10.3390/nu14091793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Magnesium (Mg) is an essential micronutrient that participates in various enzymatic reactions that regulate vital biological functions. The main aim was to assess the Mg status and its association with nutritional indicators in seventeen cystic fibrosis (CF) patients. The serum Mg and calcium (Ca) levels were determined using standardized methods and the dietary Mg intake by prospective 72 h dietary surveys. The mean serum Ca (2.45 mmol/L) and Mg (0.82 mmol/L) had normal levels, and the mean dietary intake of the Ca (127% DRI: Dietary Reference Intake) and Mg (125% DRI) were high. No patients had an abnormal serum Ca. A total of 47% of the subjects had hypomagnesemia and 12% insufficient Mg consumption. One patient had a serum Mg deficiency and inadequate Mg intake. A total of 47 and 82% of our series had a high serum Ca/Mg ratio of >4.70 (mean 4.89) and a low Ca/Mg intake ratio of <1.70 (mean 1.10), respectively. The likelihood of a high Ca/Mg ratio was 49 times higher in patients with a serum Mg deficiency than in normal serum Mg patients. Both Ca/Mg ratios were associated with the risk of developing cardiovascular disease (CVD), type 2 diabetes (T2D), metabolic syndrome (MetS), and even several cancers. Therefore, 53% of the CF patients were at high risk of a Mg deficiency and developing other chronic diseases.
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Liamis G, Hoorn EJ, Florentin M, Milionis H. An overview of diagnosis and management of drug-induced hypomagnesemia. Pharmacol Res Perspect 2021; 9:e00829. [PMID: 34278747 PMCID: PMC8287009 DOI: 10.1002/prp2.829] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
Magnesium (Mg) is commonly addressed as the "forgotten ion" in medicine. Nonetheless, hypomagnesemia should be suspected in clinical practice in patients with relevant symptomatology and also be considered a predisposing factor for the development of other electrolyte disturbances. Furthermore, chronic hypomagnesemia has been associated with diabetes mellitus and cardiovascular disease. Hypomagnesemia as a consequence of drug therapy is relatively common, with the list of drugs inducing low serum Mg levels expanding. Culprit medications linked to hypomagnesemia include antibiotics (e.g. aminoglycosides, amphotericin B), diuretics, antineoplastic drugs (cisplatin and cetuximab), calcineurin inhibitors, and proton pump inhibitors. In recent years, the mechanisms of drug-induced hypomagnesemia have been unraveled through the discovery of key Mg transporters in the gut and kidney. This narrative review of available literature focuses on the pathogenetic mechanisms underlying drug-induced hypomagnesemia in order to increase the insight of clinicians toward early diagnosis and effective management.
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Affiliation(s)
- George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Vanoni FO, Milani GP, Agostoni C, Treglia G, Faré PB, Camozzi P, Lava SAG, Bianchetti MG, Janett S. Magnesium Metabolism in Chronic Alcohol-Use Disorder: Meta-Analysis and Systematic Review. Nutrients 2021; 13:nu13061959. [PMID: 34200366 PMCID: PMC8229336 DOI: 10.3390/nu13061959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic alcohol-use disorder has been imputed as a possible cause of dietary magnesium depletion. The purpose of this study was to assess the prevalence of hypomagnesemia in chronic alcohol-use disorder, and to provide information on intracellular magnesium and on its renal handling. We carried out a structured literature search up to November 2020, which returned 2719 potentially relevant records. After excluding non-significant records, 25 were retained for the final analysis. The meta-analysis disclosed that both total and ionized circulating magnesium are markedly reduced in chronic alcohol-use disorder. The funnel plot and the Egger’s test did not disclose significant publication bias. The I2-test demonstrated significant statistical heterogeneity between studies. We also found that the skeletal muscle magnesium content is reduced and the kidney’s normal response to hypomagnesemia is blunted. In conclusion, magnesium depletion is common in chronic alcohol-use disorder. Furthermore, the kidney plays a crucial role in the development of magnesium depletion.
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Affiliation(s)
- Flora O. Vanoni
- Family Medicine Institute, Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (F.O.V.); (M.G.B.)
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
- Correspondence: ; Tel.: +39-(0)2550-38727; Fax: +39-(0)2550-32918
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giorgio Treglia
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Pietro B. Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland;
| | - Pietro Camozzi
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (P.C.); (S.J.)
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Mario G. Bianchetti
- Family Medicine Institute, Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (F.O.V.); (M.G.B.)
| | - Simone Janett
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (P.C.); (S.J.)
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Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes. Nutrients 2021; 13:nu13020320. [PMID: 33499378 PMCID: PMC7912442 DOI: 10.3390/nu13020320] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/27/2022] Open
Abstract
Magnesium (Mg2+) deficiency is probably the most underestimated electrolyte imbalance in Western countries. It is frequent in obese patients, subjects with type-2 diabetes and metabolic syndrome, both in adulthood and in childhood. This narrative review aims to offer insights into the pathophysiological mechanisms linking Mg2+ deficiency with obesity and the risk of developing metabolic syndrome and type 2 diabetes. Literature highlights critical issues about the treatment of Mg2+ deficiency, such as the lack of a clear definition of Mg2+ nutritional status, the use of different Mg2+ salts and dosage and the different duration of the Mg2+ supplementation. Despite the lack of agreement, an appropriate dietary pattern, including the right intake of Mg2+, improves metabolic syndrome by reducing blood pressure, hyperglycemia, and hypertriglyceridemia. This occurs through the modulation of gene expression and proteomic profile as well as through a positive influence on the composition of the intestinal microbiota and the metabolism of vitamins B1 and D.
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McLean C, Tapsell L, Grafenauer S, McMahon AT. Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit. Alcohol Alcohol 2020; 55:489-496. [PMID: 32628260 DOI: 10.1093/alcalc/agaa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. METHODS A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013-2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. RESULTS A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22-70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70-27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0-6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300-6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. CONCLUSION Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.
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Affiliation(s)
- Cameron McLean
- Nutrition and Dietetics Department, St George Hospital, Kogarah, 2217 New South Wales, Australia.,Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, 2500 New South Wales, Australia
| | - Linda Tapsell
- Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, 2500 New South Wales, Australia
| | - Sara Grafenauer
- Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia
| | - Anne-Therese McMahon
- Public Health Nutrition, School of Health and Society, University of Wollongong, 2500 New South Wales, Australia
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Forrest E. Alcohol-related liver disease results in significant long-term mortality irrespective of the presence of steatohepatitis. J Hepatol 2020; 73:459. [PMID: 32327361 DOI: 10.1016/j.jhep.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/21/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
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Maguire D, Talwar D, Burns A, Catchpole A, Stefanowicz F, Robson G, Ross DP, Young D, Ireland A, Forrest E, Galloway P, Adamson M, Colgan E, Bell H, Orr L, Kerr JL, Roussis X, McMillan DC. A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome. J Transl Med 2019; 17:384. [PMID: 31752901 PMCID: PMC6873772 DOI: 10.1186/s12967-019-02141-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS. Methods Patients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded. Results The majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275–675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05). Conclusion The prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.
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Affiliation(s)
- Donogh Maguire
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK. .,Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK.
| | - Dinesh Talwar
- The Scottish Trace Element and Micronutrient Diagnostic and Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - Alana Burns
- The Scottish Trace Element and Micronutrient Diagnostic and Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK.,Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, G51 4TF, Scotland, UK
| | - Anthony Catchpole
- The Scottish Trace Element and Micronutrient Diagnostic and Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - Fiona Stefanowicz
- The Scottish Trace Element and Micronutrient Diagnostic and Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - Gordon Robson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - David P Ross
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK.,Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, Scotland, UK
| | - Alastair Ireland
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, G4 0SF, Scotland, UK
| | - Peter Galloway
- Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, G51 4TF, Scotland, UK
| | - Michael Adamson
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Eoghan Colgan
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Hannah Bell
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Lesley Orr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Joanna-Lee Kerr
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Xen Roussis
- Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
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