Magnesium is an essential mineral that is critical for many cellular functions in the body. Its role in the treatment of serious illnesses in pediatric patients has recently gained increasing recognition. A review paper from India examines the role of magnesium in pediatric intensive care.
Magnesium underlies important physiological processes in the human body. It is a cofactor for more than 300 enzymatic reactions and is crucial for energy production, protein synthesis and cell metabolism. It also plays a key role in the regulation of neuromuscular function and contributes to the functioning of muscles and nerves.
Magnesium is crucial for maintaining cellular homeostasis by stabilizing cell membranes and facilitating the synthesis of nucleic acids. It also contributes to the regulation of cardiac rhythm and to the support of general cardiac function. In the context of pediatric intensive care, the importance of magnesium becomes even clearer. Dr. Accha Nandini Sagar of the Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India, and colleagues conducted a comprehensive study in which they analyzed the role of magnesium in pediatric critical care, examining its physiological mechanisms, clinical implications, and therapeutic applications [1]. The objectives of their study were to elucidate the physiological functions of magnesium and its key role in maintaining health and to assess the clinical impact of magnesium deficiency in critically ill pediatric patients.
Magnesium deficiency can occur in seriously ill children due to several factors. One of the main causes is increased magnesium loss due to renal dysfunction. The excretion of magnesium from the gastrointestinal tract, e.g. through diarrhea, can also exacerbate magnesium deficiency. In addition, diuretics, which are often administered in intensive care, can also increase magnesium excretion via the urine. Inadequate nutrition is another factor, especially in patients who cannot eat or receive parenteral nutrition without adequate magnesium supplementation. In addition, certain conditions such as sepsis, trauma and burns can increase the metabolic demand for magnesium or disrupt its homeostasis, which can lead to deficiencies of up to 65% in critically ill pediatric patients.
Various symptoms of magnesium deficiency
The symptoms of magnesium deficiency in critically ill children can be varied and severe. Neurologically, pediatric patients may experience symptoms such as muscle weakness, seizures and increased neuromuscular excitability leading to tetany and tremor. In terms of the cardiovascular system, magnesium deficiency is associated with cardiac arrhythmias, increased heart rate and hypertension, emphasizing the key role of magnesium in cardiac function, the authors write. Musculoskeletal symptoms may include muscle spasms and cramps due to neuromuscular transmission disorders. General symptoms such as fatigue, irritability and altered mental status may also indicate magnesium deficiency and complicate the overall clinical picture.
To diagnose magnesium deficiency, the magnesium level in the blood serum is usually measured. However, the authors emphasize that the serum level may not accurately reflect the total magnesium stores in the body, so a comprehensive clinical assessment is required. This includes medical history and physical examination, which are necessary to identify risk factors and symptoms associated with deficiency. Assessment of other electrolyte levels is also essential, as hypomagnesemia is often associated with hypocalcemia and hypokalemia, further complicating clinical management in critically ill patients.
In addition to the cardiovascular system and neurological functions, magnesium is also crucial for muscle function, and a magnesium deficiency can lead to muscle weakness and cramps that affect mobility and general rehabilitation, especially in patients who require mechanical ventilation or suffer from neuromuscular disorders.
Supplementation improves clinical results
Magnesium supplementation in pediatric critical care is essential for the treatment of various clinical conditions. It plays an important role in the treatment of hypomagnesemia, a common problem in critically ill patients that can lead to serious complications such as cardiac arrhythmias and increased mortality. In addition, magnesium is indicated in the treatment of severe asthma exacerbations, where it can help improve lung function and reduce hospital admissions. Magnesium is also effective in the treatment of cardiac arrhythmias, particularly conditions such as torsades de pointes and rapid atrial fibrillation. In addition, it may be beneficial for patients with neuromuscular disorders and those suffering from sepsis or inflammation due to its immunomodulatory effects
Intravenous (IV) administration is often used in acute illnesses for rapid correction of hypomagnesemia or severe asthma attacks. Typical doses often start at 1-2 g administered over a period of 15-30 minutes to allow a rapid response in critical situations. Another option is oral supplementation, which is particularly important for maintenance therapy or less acute cases, with doses typically ranging from 200-400 mg daily, depending on the patient’s needs and tolerance. According to the authors, in some cases a continuous intravenous infusion may be necessary to maintain adequate magnesium levels, especially in patients with continuous losses or high requirements.
Dr. Sagar and colleagues emphasize that regular monitoring of serum magnesium levels is essential, especially in patients with impaired renal function or those receiving high doses of magnesium. It is crucial to ensure the safety and efficacy of magnesium therapy. Physicians should also be alert to clinical signs of magnesium deficiency, such as muscle cramps and cardiac arrhythmias, as well as signs of toxicity, including respiratory depression and hypotension. Renal function should be considered, as patients with impaired renal function may need to have their magnesium dose adjusted based on their serum levels and overall renal function.
Patients with renal failure in particular may experience hypermagnesemia, which can lead to symptoms such as hypotension, respiratory depression and even cardiac arrest. Elevated magnesium levels can also have neuromuscular effects, such as muscle weakness and reduced reflexes. In addition, magnesium can interact with certain medications such as diuretics and antibiotics, impairing their absorption and effectiveness. With oral magnesium supplementation, some patients may experience gastrointestinal disturbances such as diarrhea or discomfort.
Important for prevention and therapy
The importance of magnesium in clinical practice has increased considerably in recent years. Magnesium plays a decisive therapeutic and preventive role in many diseases, especially in the treatment of critical illnesses in pediatric patients.
Retrospective studies have shown that hypomagnesemia is associated with an increased risk of sepsis, with a strong correlation in the odds ratio. In addition, cohort studies have recently shown that administration of magnesium sulfate can improve lactate clearance in patients with sepsis, suggesting a potential therapeutic role. Dr. Sagar et al. note that the use of magnesium sulfate was associated with lower 28-day all-cause mortality in critically ill patients with sepsis, underscoring the protective effect of magnesium. In addition, magnesium is crucial in the treatment of acute respiratory distress syndrome (ARDS): hypomagnesemia can lead to respiratory muscle weakness and exacerbate conditions such as ARDS. While there are few specific studies on the direct effects of magnesium on ARDS in pediatric patients, its role in modulating inflammatory responses suggests a potential benefit in treating the condition, the authors point out.
In pediatric emergencies for the treatment of seizures, studies confirm the efficacy of magnesium sulfate in reducing seizure frequency and improving outcomes in critically ill children. In addition, the role of magnesium in protecting neuronal integrity during hypoxia may contribute to improved outcomes in pediatric patients with neurological disorders.
Several professional organizations have issued guidelines that emphasize the importance of magnesium in the treatment of critically ill pediatric patients. The American Heart Association recommends the administration of magnesium sulfate at a dose of 50 mg/kg (maximum 2 g) for conditions such as torsades de pointes and severe asthma exacerbations, infused over a 10-minute period. This guideline emphasizes the critical role of timely magnesium treatment in life-threatening situations. The National Asthma Education and Prevention Program also includes magnesium sulfate as an adjunct therapy for severe asthma attacks, especially in emergency situations, supporting its effectiveness in improving respiratory function.
Given the high prevalence of magnesium imbalances in critically ill pediatric patients, regular monitoring of serum magnesium levels is recommended. In addition, patients diagnosed with hypomagnesemia should be administered intravenous magnesium sulfate according to established dosing guidelines. Treatment should be tailored to the clinical scenario and take into account factors such as the patient’s general condition and any concomitant electrolyte disturbances, the authors write. Integrating magnesium therapy into the overall treatment plan for critically ill children is crucial, especially for patients with conditions such as asthma or cardiac arrhythmias.
Literature:
- Sagar AN, et al.: A Comprehensive Review of the Role of Magnesium in Critical Care Pediatrics: Mechanisms, Clinical Impact, and Therapeutic Strategies. Cureus 2024; 16(8): e66643; doi: 10.7759/cureus.
HAUSARZT PRAXIS 2024; 19(12): 36–37
