Biomedical Science Letters (대한의생명과학회지)

The Korean Society for Biomedical Laboratory Sciences (대한의생명과학회)
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Change of Blood Magnesium Level in Diabetes Patients Undergoing Off-pump Coronary Artery Bypass Grafting

  • Seo, Si-Young (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Moon, Seong-Min (Department of Biomedical Laboratory of Science, College of Smart Foods and Drugs, Inje University) ;
  • Hyun, Kyung-Yae (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Kim, Chong-Rak (Department of Biomedical Laboratory of Science, College of Smart Foods and Drugs, Inje University) ;
  • Choi, Seok-Cheol (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan)
  • Published : 2009.09.30
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Abstract

We carried out this study to investigate differences of physiological variables between patients with (DM group) and without type II diabetes mellitus (Non-DM group) undergoing off-pump coronary artery bypass grafting (OPCABG). Postoperative $Mg^{++}$ and $Ca^{++}$ levels were lower, whereas $Na^+$ level was higher in DM group than those in Non-DM group. ICU (intensive care unit) stay time in DM group was longer than that of Non-DM group. Postoperative platelet counts tended to decrease, whereas C-reactive protein (CRP) and cardiac troponin-I (cTNI) levels tended to increase in DM group compared with Non-DM group. Postoperative albumin level was lower, while blood urea nitrogen (BUN) and creatinine levels were greater in DM group than those in Non-DM group. DM group had higher incidence of post-operative arrhythmias than Non-DM group. These results reveal that type II DM patients undergoing OPCAB may have higher incidences of postoperative hypomagnesemia, hypocalcemia and arrhythmias, and increases of CRP, cTNI, BUN, and creatinine levels than in Non-DM patients undergoing OPCAB. The perioperative check and control (supplement) of $Mg^{++}$ levels should be considered in cardiovascular surgery combined with DM.

Keywords

References

  1. Al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiologic and clinical overview. Am J Kidney Dis. 1994. 24: 737-752. https://doi.org/10.1016/S0272-6386(12)80667-6
  2. Arsenian MA. Magnesium and cardiovascular disease. Prog Cardiovasc Dis. 1993. 35: 271-310. https://doi.org/10.1016/0033-0620(93)90008-2
  3. Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, Pineo A, Busardo A, Paolisso G. Role of magnesium in insulin action diabetes and cardio-metabolic syndrome. Mol Aspects Med. 2003. 24: 39-52. https://doi.org/10.1016/S0098-2997(02)00090-0
  4. Baxter GF, Sumeray MS, Walker JM. Infarct size and magnesium: insights into LIMIT-2 and ISIS-4 from experimental studies [comments]. Lancet 1996. 348: 1424-1426. https://doi.org/10.1016/S0140-6736(96)07281-9
  5. Chernow B, Bamberger S, Stoiko M, Vadnais M, Mills S, Hoellerich V, Warshaw AL. Hypomagnesemia in patients in postoperative intensive care. Chest 1989. 95: 391-397. https://doi.org/10.1378/chest.95.2.391
  6. Dacey MJ. Hypomagnesemic disorders. Critical Care Clinics 2001. 17: 155-173. https://doi.org/10.1016/S0749-0704(05)70157-3
  7. de Leeuw PW, Falke HE, Kho TL, Vandongen R, Wester A, Birkenhäger WH. Effects of beta-adrenergic blockade on diurnal variability of blood pressure and plasma noradrenaline levels. Acta Med Scand. 1977. 202: 389-392. https://doi.org/10.1111/j.0954-6820.1977.tb16849.x
  8. Ferrari R, Albertini A, Curello S. Myocardial recovery during post-ischemic reperfusion: Effects of nifidepine, calcium and magnesium. J Mol Cell Cardiol. 1986. 18: 487-498. https://doi.org/10.1016/S0022-2828(86)80914-2
  9. Flatman P, Lew V. The magnesium dependence of sodium pump mediate sodium-potassium and sodium-sodium exchange in intact human red cells. J Physiol. 1981. 815: 421-446.
  10. Gums JG. Magnesium in cardiovascular and other disorders. Am J Health-Syst Pharm. 2004. 61: 1569-1576.
  11. Hasegawa J, Matsumoto T, Takami T, Fujimoto Y, Kotake H, Mashiba H. Suppression of catecholamine-induced abnormal pacemaker activities by magnesium ion in guinea pig cardiac muscle cells. Magnesium 1989. 8: 94-99.
  12. Herzog WR, Serebruany VL. How magnesium therapy may influence clinical outcome in acute myocardial infarction: review of potential mechanisms. Coron Artery Dis. 1996. 7: 364-370. https://doi.org/10.1097/00019501-199605000-00006
  13. Hazelrigg SR, Boley TM, Cetindag IB, Uoulton KP, Trammell GL, Polancic JE, Shawgo TS, Quin JA, Verhulst S. The efficacy of supplemental magnesium in reducing atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2004. 77: 824-830. https://doi.org/10.1016/j.athoracsur.2003.08.027
  14. Hoeldtke RD, Cilmi KM. Effects of aging on catecholamine metabolism. J Clin Endocrinol Met. 1985. 60: 479-484. https://doi.org/10.1210/jcem-60-3-479
  15. Kalman J M, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, Tonkin AM. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995. 60: 1709-1715. https://doi.org/10.1016/0003-4975(95)00718-0
  16. Koch SM, Warters RD, Mehlhorn U. The simultaneous measurement of ionized and total calcium and ionized and total magnesium in intensive care unit patients. J Critical Care 2002. 17: 203-205. https://doi.org/10.1053/jcrc.2002.35813
  17. Koch SM, Mehlhorn U, Baggstrom E, Donovan D, Allen SJ. Hypercalcitoninemia and inappropriate calciuria in the acute trauma patient. J Crit Care 1996. 11: 117-121. https://doi.org/10.1016/S0883-9441(96)90007-6
  18. Lee SC, Kim YT, Moon SM, Hyun KY, Kim DS, Choi SC. Factors affecting the postoperative outcome in adult cardiac surgery with cardiopulmonary bypass. Korean J Life Sci. 2008. 18: 1493-1546. https://doi.org/10.5352/JLS.2008.18.11.1493
  19. McIntosh TK, Vink R, Yamakami I, Faden AI. Magnesium protects against neurological deficit after brain injury. Brain Res. 1989. 482: 252-260. https://doi.org/10.1016/0006-8993(89)91188-8
  20. McNair P, Christensen MS, Christiansen C, Madsbad S, Transbol I. Renal hypomagnesaemia in human diabetes mellitus: its relation to glucose homeostasis. Eur J Clin Invest. 1982. 12: 81-85. https://doi.org/10.1111/j.1365-2362.1982.tb00942.x
  21. Moon SM, Kang SB, Hyun KY, Choi SC. Antiinflammatory and myocardial protective effects of magnesium in patients undergoing valvular heart surgery. Korean J Life Sci. 2007. 17: 1539-1546. https://doi.org/10.5352/JLS.2007.17.11.1539
  22. Pakfetrat M, Malekmakan L, Roozbeh J, Haghpanah S. Magnesium and its relationship to C-reactive protein among hemodialysis patients. Magnes Res. 2008. 21: 167-170.
  23. Romani A, Scarpa A. Hormonal control of Mg2+ transport in the heart. Nature 1990. 346: 841-844. https://doi.org/10.1038/346841a0
  24. Saris NE, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium. An update on physiological, clinical and analytical aspects. Clin Chim Acta. 2000. 294: 1-26. https://doi.org/10.1016/S0009-8981(99)00258-2
  25. Shattock MJ. Myocardial stunning: do we know the mechanism- Basic Res Cardiol. 1997. 2: 18-22.
  26. Shechter M, Merz CN, Paul-Labrador M, Meisel SR, Rude RK, Molloy MD, Dwyer JH, Shah PK, Kaul S. Oral magnesium supplementation inhibits platelet-dependent thrombosis in patients with coronary artery disease. Am J Cardiol. 1999. 84: 152-156.
  27. Toraman F, Karabulut EH, Alhan HC, Dagdelen S, Tarcan S. Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2001. 72: 1256-1262. https://doi.org/10.1016/S0003-4975(01)02898-3
  28. Weglicki WB, Phillips TM, Freedman AM, Cassidy MM, Dickens BF. 1992. Magnesium-deficiency elevates circulating levels of inflammatory cytokines and endothelin. Mol Cell Biochem. 110, 169-173. https://doi.org/10.1007/BF02454195
  29. Wesley RC Jr, Haines DE, Lerman BB, DiMarco JP, Crampton RS. Effect of intravenous magnesium sulfate on supraventricular tachycardia. Am J Cardiol. 1989. 63: 1129-1131. https://doi.org/10.1016/0002-9149(89)90092-1
  30. Woods KL, Fletcher S, Roffe C, Haider Y. Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992. 339: 1553-1558. https://doi.org/10.1016/0140-6736(92)91828-V
  31. Zaloga GP, Robert PR. Calcium, phosphorus and magnesium disorders. In Ayres SM, Grenvik NA, Holbrook PR, Shoemaker WC (eds): Textbook of critical care, 4th ed. WB Saunders, 2000. pp 905-928.
  32. Zaman AG, Alamgir F, Richens T, Williams R, Rothman MT, Mills PG. The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery. Heart 1997. 77: 527-531. https://doi.org/10.1136/hrt.77.6.527