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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Magnesium (Mg(2+)) depletion can have detrimental effects in postcardiac arrest patients through multiple potential mechanisms. Therapeutic hypothermia (TH) produces a Mg(2+) diuresis, but the effects of postcardiac arrest TH on serum Mg(2+) levels in patients with postcardiac arrest syndrome (PCAS) are yet to be systematically quantified. We conducted a retrospective chart review of 119 consecutive comatose PCAS patients treated with TH between 2005 and 2010 and compared them to 33 matched historic controls (HCs) seen at the same institution between 2002 and 2005 who were not treated with TH. We abstracted data from the first 96 hours postarrest, including date, time, and value of serum Mg(2+) levels and date, time, and amount of Mg(2+) repletion, along with outcomes at discharge. The median Mg(2+) level of TH patients was 2.0 mg/dL [interquartile range (IQR), 1.9-2.2 mg/dL] (0.82 mmol/L [IQR, 0.78-0.90 mmol/L]) versus 2.2 mg/dL [IQR, 1.9-2.4 mg/dL] (0.90 mmol/L [IQR, 0.82-0.99 mmol/L]) (p=0.2) in HCs. In addition, 42.9% (520/1214) of Mg(2+) levels in TH patients versus 31.9% (43/135) (p=0.014) in HC patients were below 2.0 mg/dL [0.82 mmol/L]. The average number of times the Mg(2+) level was checked in TH patients was 10.2 (range 1-18) versus 4.1 (range 1-10) in HCs. The TH patients were more likely to receive supplemental Mg(2+) than HCs (81.5% [97/119] vs. 27.3% [9/33] [p<0.01]). The mean supplemental Mg(2+) dose was 1.9 g for TH patients versus 0.5 g for HC patients. Mortality in patients treated with TH was 53.1% (60/113) versus 78.6% (22/28) (p=0.014) in HCs. Low serum Mg(2+) levels with subsequent Mg(2+) supplementation were more common in comatose patients with PCAS treated with TH compared to normothermic HC patients. The effect of untreated hypomagnesemia on postcardiac arrest outcomes remains to be determined.
Ther Hypothermia Temp Manag 2014 Dec
PMID:Magnesium depletion in patients treated with therapeutic hypothermia after cardiac arrest. 2524 97

Magnesium plays important roles in many physiologic functions including protein synthesis, bone development, and cell membrane function. There is some evidence to suggest a role for magnesium sulfate as a therapeutic neuroprotective agent along with therapeutic hypothermia in infants with hypoxic-ischemic encephalopathy, but studies are inconclusive. Ischemic insult and hypothermia may both play a role in altered magnesium levels in this population.
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PMID:Hypoxic-Ischemic Encephalopathy and Serum Magnesium Monitoring and Maintenance. 2719 11

Magnesium is an intracellular cation essential for many en-zymatic processes and cellular functions. Magnesium sulfate acts as an endogenous calcium channel antagonist at neuronal synapses, thought to prevent excessive activation of N-methyl-D-aspartate receptors by excitatory amino acids, such as glutamate, and by downregulation of proinflammatory pathways. Early intervention is essential in the prevention of the secondary phase of neuronal injury. The immature brain is particularly prone to excitotoxicity, and inflammation has been strongly implicated in the pathogenesis of cerebral palsy. This article explores the current status of magnesium being used as an adjunct to hypothermia in term neonatal encephalopathy (NE) against a background of its use in other populations. There is some evidence for magnesium sulfate as a neuroprotective agent, however animal studies of NE at term equivalent age have been confounded by concomitant hypothermia induced by magnesium itself. Nevertheless, the combination of magnesium and cooling has been shown to be more effective than either treatment alone in adult rodents. In the preterm baby, magnesium sulfate given antenatally in threatened preterm labor has demonstrated a significant reduction in the risk of cerebral palsy at 2 years of age, though the benefit is not clear at school age. In adult clinical studies of ischemic and hemorrhagic stroke, there have been disappointing results for magnesium sulfate as a neuroprotective strategy. Importantly, clinical neurological scores may be affected by the increased hypotonia observed. We suggest that magnesium sulfate should be carefully re-evaluated as a neuroprotective agent given its favorable safety profile, relative low cost, and widespread availability.
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PMID:Magnesium as a Neuroprotective Agent: A Review of Its Use in the Fetus, Term Infant with Neonatal Encephalopathy, and the Adult Stroke Patient. 2940 14


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