title: The Association Between Admission Magnesium Concentrations and Lactic Acidosis in Critical Illness.
abstract: BACKGROUND
  Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined.
  
  
  METHODS
  This was a retrospective, cross-sectional study conducted at a 77 ICU bed tertiary medical center. Data pertaining to the first unique admission of any ICU patient between 2001 and 2008 were extracted from the Multiparameter Intelligent Monitoring in Intensive Care database. Hypomagnesemia was defined as serum magnesium <1.6 mg/dL. Mild and severe lactic acidosis were defined as lactate concentrations of >2 and > 4 mmol/L, respectively. Multivariate modeling was used to explore the association between magnesium and lactate concentrations.
  
  
  RESULTS
  Of 8922 critically ill patients, 22.6% were hypomagnesemic. Hypomagnesemia was associated with an increased adjusted risk of mild lactic acidosis (odds ratio [OR] 1.71, 95% confidence interval [95%CI] 1.51-1.94, P < .001) and severe lactic acidosis (OR 1.56, 95%CI 1.32-1.84, P < .001) than the reference quartile. The association between hypomagnesemia and mild lactic acidosis was stronger in those at risk of magnesium deficiency, including diabetics (OR 2.02, 95%CI 1.51-2.72, P < .001) and alcoholics (OR 1.92, 95%CI 1.16-3.19, P = .01). As an internal model control, hypokalemia was not associated with an increased risk of lactic acidosis.
  
  
  CONCLUSIONS
  Magnesium deficiency is a common finding in patients admitted to the ICU and is associated with lactic acidosis. Our findings support the biologic role of magnesium in metabolism and raise the possibility that hypomagnesemia is a correctable risk factor for lactic acidosis in critical illness.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA amoskowi@bidmc.harvard.edu.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.affiliation: Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Mark
authors.affiliation: Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Danziger
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000209:etiology* / Q000401:mortality; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008275:Magnesium Deficiency / Q000097:blood / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acidosis; critical illness; lactic; magnesium deficiency; nutritional deficiency; oxidative phosphorylation
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