Serum ionized magnesium in premature and term infants

Reference intervals and age-related changes for venous biochemical, hematological, electrolytic, and blood gas variables using a point of care analyzer in 68 puppies

OBJECTIVE

To determine the reference interval for various venous analyte concentrations using a point-of-care (POC) analyzer in healthy, 4-84-day-old puppies and identify any age-specific variations in the values as compared with adults.

DESIGN

A prospective cohort study.

SETTING

University teaching hospital.

ANIMALS

Clinically healthy dogs; 68 puppies and 30 adults.

MEASUREMENTS AND MAIN RESULTS

Samples were collected by jugular venipuncture from 68 clinically healthy puppies at 4, 10, 12, 16, 28, 70, 77, and 84 days of age and once each from 30 clinically healthy adult dogs. Blood samples (n = 287) were analyzed within 5 minutes of collection using an automated POC analyzer. Reference intervals for puppies at various ages were estimated using a bootstrap sampling approach. The analytes that were closest to the adult values were pH and bicarbonate. On days 4 and 10 the pH for puppies was higher than the adults while the HCO3 was higher than the adults only on day 4. HCT on day 4 approximated adult values but fell to a nadir on day 28 before rising toward adult levels. At all time points, sodium, chloride, and ionized magnesium concentrations were lower than adult values, and potassium and ionized calcium were higher than adult values. Glucose was similar to adult values on day 4 but was above adult values at all other time points. Blood urea nitrogen (BUN) was higher in puppies until day 28 when it became lower than in adults. BUN levels remained lower than adults through day 84.

CONCLUSIONS

Variations exist between puppies and adults for venous POC analyzer results. Adult reference intervals should not be used for puppies as this might cause misinterpretation of the results.

The Emergency Department Approach to Newborn and Childhood Metabolic Crisis

For most emergency medicine physicians, the phrases "newborn workup" and "metabolic disease" are, at best, uncomfortable. This article, however, provides a simple approach to the recognition,evaluation, and treatment of infants with all manners of metabolic issues, including hypoglycemia, inborn errors of metabolism, jaundice, and electrolyte abnormalities. The disorders are grouped based on symptomatology, and have simple guidelines for work-up and management, with an emergency department practitioner perspective in mind.

Magnesium sulfate effect on erythrocyte membranes of asphyxiated newborns

OBJECTIVES

Magnesium sulfate has been recognized as a neuroprotective agent against hypoxia-ischemia, mainly by the protection from the excitotoxicity associated with increased glutamate concentration. However, the mechanism of MgSO4 action is not fully understood and is considerably controversial.

DESIGN AND METHODS

During the 2 first hours of life, the asphyxiated full-term newborns were treated intravenously with one dose of MgSO4 250 mg/kg body weight. At birth, after 6 and 48 h of life the activity of ATP-dependent enzymes in erythrocyte membranes: Mg2+-ATPase, Ca2+-ATPase, protein kinases A and C, were determined. Using monoclonal antibodies, the band 3 and its phosphotyrosine level were also assayed.

RESULTS

The time-dependent decrease of Ca2+-ATPase activity was detected in untreated newborns, whereas MgSO4 prevented this reduction. After 48 h, protein kinases activities differed in MgSO4-treated and untreated groups. Magnesium therapy increased the amount of band 3 and diminished proteolytic degradation of this protein.

CONCLUSION

Our results demonstrated, for the first time, that magnesium sulfate treatment significantly altered the activities of some important enzymes in erythrocyte membrane from asphyxiated newborns. It also reduced the post-asphyxial damages of membrane compounds. These data may partly explain the molecular mechanisms of MgSO4 action in asphyxiated newborns.

Plasma Ionized Magnesium Levelsin Neonatal Respir atory Distress Syndrome

Measurement of ionized magnesium (IMg) provides an accurate assessment of the free form of Mg, which is the physiologically active form and is most reflective of the biologically active and not easily measurable intracellular Mg fraction. Plasma levels of IMg were measured by ion-selective electrode method in premature newborns with respiratory distress syndrome (RDS), and relationships and correlations between IMg levels and various demographic, prognostic and laboratory characteristics were investigated by comparing the premature newborns with (study group; n = 19) and without RDS (control group; n = 20) in the present study. The values of the postnatal arterial pH and base excess and plasma IMg levels were significantly different between the study and control groups, and the number of newborns with any morbidity was significantly higher in the study group. Within the study group there were significant negative correlations between the plasma IMg levels and the values of the umbilical cord arterial pH (r = -0.621, p = 0.005) and base excess (r = -0.746, p = 0.001), and the value of the postnatal arterial base excess (r = -0.585, p = 0.008). The newborns who died later had higher plasma IMg levels than those who survived (0.89 +/- 0.45 vs. 0.63 +/- 0.24 mmol/l, p = 0.026). These findings suggest that increase of plasma IMg may be due to extracellular movement of Mg, which is a principally intracellular ion, as a result of acidosis, hypoxia and probable cellular injury during the early course of RDS. The exact pathophysiological mechanism responsible for IMg increase, and whether determination of plasma IMg level, including umbilical cord blood IMg measurement, can be used as an early or predictive indicator of RDS in the diagnosis remain to be determined in further large-scale studies.

Evaluation of plasma ionized magnesium levels in neonatal hyperbilirubinemia

Plasma levels of ionized magnesium (IMg) measured by ion-selective electrode were investigated in neonatal hyperbilirubinemia by comparing the newborns with (> or =205 microM) and without (<205 microM) significant hyperbilirubinemia (groups of severe and moderate hyperbilirubinemia, respectively). Serum bilirubin, plasma IMg, and ionized calcium (ICa) levels were determined in 165 healthy term newborns with nonhemolytic indirect hyperbilirubinemia during the first 10 d of life. Mean serum bilirubin, plasma IMg, and ICa levels were 200.1 +/- 126.5 microM, 0.54 +/- 0.12 mM, and 1.15 +/- 0.12 mM, respectively, in 165 newborns whose mean postnatal age was 156.1 +/- 46.5 h, and there was a significant positive correlation between the mean serum bilirubin and plasma IMg levels (r = 0.535, p < 0.001). Serum bilirubin levels (304.4 +/- 83.8 microM versus 94.1 +/- 54.7 microM) and plasma IMg levels (0.6 +/- 0.12 mM versus 0.49 +/- 0.1 mM) were significantly higher and plasma ICa levels (1.13 +/- 0.12 mM versus 1.18 +/- 0.12 mM) were significantly lower in the group of severe hyperbilirubinemia (n = 83) when compared with the group with moderate hyperbilirubinemia (n = 82). Seventeen of the 83 cases of severe hyperbilirubinemia had IMg levels above the normal range (> or =0.69 mM), whereas none of the 82 cases of moderate hyperbilirubinemia had elevated IMg levels. Fifteen of the 17 with high IMg levels had bilirubin levels >290 microM. Results of the present study suggest that increase in plasma IMg may be due to extracellular movement of Mg, a principally intracellular ion, resulting from generalized cellular injury including neurons and erythrocytes. Considering neuroprotective functions and beneficial effects of Mg ion in improving neurologic outcome, we also may speculate the possibility of a neuroprotective role or a compensatory mechanism in IMg increase against emerging toxicity risk of increasing serum bilirubin levels.

Exposure of piglet coronary arterial muscle cells to low concentrations of Mg2+ found in blood of ischemic heart disease patients result in rapid elevation of cytosolic Ca2+: relevance to sudden infant death syndrome

Exposure of cultured piglet primary neonatal coronary arterial smooth muscle cells to concentrations of ionized Mg2+ ([Mg2+]o (i.e., 0.48, 0.3, 0.15 mM) found in blood of patients presenting with ischemic heart disease and in hypoxic neonates resulted in concentration-dependent elevation in intracellular free Ca2+ ions ([Ca2+]i; the lower the [Mg2+]o, the higher the [Ca2+]i rise. The lowest concentration of [Mg2+]o tested, i.e., 0.15 mM, resulted in a clear rounding-up (i.e., contraction) of many of the coronary smooth muscle cells; reintroduction of normal 1.2 mM [Mg2+]o failed to restore either normal [Ca2+]i or cell shape.