Role of Serum Magnesium as a Prognostic Indicator in Diabetic Critically Ill Patients
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Abstract
Introduction: Critical illness is a state of ill health with vital organ dysfunction, the severity is assessed by APACHE II. Diabetes Mellitus commonest co-morbid in critically patient characterised by hyperglycaemia leading to macro and micro-vascular complications. Magnesium is cofactor for wide range of enzymes, transporters and nucleic acids and essential for normal neuromuscular activity, normal cellular function, replication, and energy metabolism and plays a key role in regulating insulin action, insulin-mediated-glucose uptake vascular tone. Hypomagnesaemia in Diabetes is due to impaired tubular magnesium re-absorption, osmotic diuresis and acidosis.
Materials &Methods: Retrospective study for 18 months at SSMC, Tumakuru, by collecting data from MRD, analysed for age, sex, Magnesium, Sugar, APACHE II, Need and Duration of ventilator, ICU stay and mortality.
Results: 73 (48.6%) were Diabetics and 77(51.4%) were Nondiabetics. Mean age is 60 in Hypomagnesemic diabetics, 63 in Normomagnesemic diabetics and 55 in Nondiabetics. Male preponderance of 58.9% in both Diabetic and Non diabetics. Prevalence of Hypomagnesaemia is 50.6% in Diabetic and 35.06% in Nondiabetics and this relation between hypomagnesemia and Diabetics is highly statistically significant as p-value is <0.001. Mean APACHE II in Hypomagnesemic diabetics is 24.8, Normomagnesemic diabetics 21.5 and Nondiabetics 16.9. Mean ICU stay in Hypomagnesemic diabetics is 5.9 days, Normomagnesemic diabetics 3.5 days and Nondiabetics 2.8 days. 41.1% Hypomagnesemia diabetics ,15.06% Normomagnesemic diabetics and 32.46% Nondiabetic needed ventilator. Mean Duration is 99.9hrs in Hypomagnesemic diabetics, 31.2 hrs in Normomagnesemic diabetics and 39.72 hrs in Nondiabetics. Mean Mortality in Hypomagnesemic diabetics 25.4, Normomagnesemic diabetics 19.8 and Nondiabetics 21.6. Relation between hypomagnesemia and severity of critical illness in Diabetics is highly statistically significant as p-value <0.001 in ICU Duration, p-value <0.001 in Need for Ventilator and p-value <0.001 in Duration of Ventilation.
Conclusion:Hypomagnesemia is commonly observed in Diabetic critically ill patients and can be used as a prognostic indicator to assess the severity of critical illness
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