CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1779428
Original Article

Effect of Serum Ionic Magnesium on Neurological Outcome in Severe Traumatic Brain Injury Patients: A Prospective Study

1   Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
,
Surendra Jain
1   Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
,
Sushil Acharya
2   Department of Neurosurgery, JLN Medical College, Ajmer, Rajasthan, India
,
Ashok Gupta
1   Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
› Author Affiliations

Abstract

Background Magnesium is considered to have important role in cytotoxic and reperfusion pathways, deficiency of which may lead to secondary brain injuries; thus, hypomagnesemia is thought to be detrimental in traumatic brain injury (TBI) patients. The aim of this study was to evaluate the relationship between serum ionic magnesium level and neurological outcome in severe TBI patients.

Materials and Methods Eighty-four patients with severe TBI aged between 20 and 80 years admitted within 24 hours of injury included in our study. All patients were divided into two categories on the basis of initial serum magnesium levels as low serum magnesium level and normal serum magnesium level. Data was collected on the basis of age, gender, Glasgow Coma Scale (GCS) at the time of admission, and neurological outcome evaluation done on the basis of Glasgow Outcome Scale (GOS) at the end of 6 months.

Results Among the total patients, 32 patients had low serum magnesium level (< 1.6 mg/dL) at the time of admission. About 87.5% patients with low serum magnesium level had poor neurological outcome as compared to 12.5% of patients (p < 0.001) had good neurological outcome evaluated on the basis of GOS. Logistic regression model identified low Mg level (odds ratio = 6.593, p = 0.002) and GCS score less than 5 (odds ratio = 3.099, p = 0.028) as independent predictors of TBI.

Conclusion Hypomagnesemia seems to be an independent prognostic marker in severe TBI that can lead to poorer outcomes.



Publication History

Article published online:
24 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 1999; 14 (06) 602-615
  • 2 Hukkelhoven CW, Steyerberg EW, Habbema JD. et al. Predicting outcome after traumatic brain injury: development and validation of a prognostic score based on admission characteristics. J Neurotrauma 2005; 22 (10) 1025-1039
  • 3 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905): 480-484
  • 4 Broman SH, Michel ME. Traumatic Head Injury in Children. Oxford University Press, New York; 1995
  • 5 Levin HS, Aldrich EF, Saydjari C. et al. Severe head injury in children: experience of the Traumatic Coma Data Bank. Neurosurgery 1992; 31 (03) 435-443 , discussion 443–444
  • 6 van der Naalt J, Hew JM, van Zomeren AH, Sluiter WJ, Minderhoud JM. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol 1999; 46 (01) 70-78
  • 7 Reilly PL. Brain injury: the pathophysiology of the first hours. 'Talk and Die revisited'. J Clin Neurosci 2001; 8 (05) 398-403
  • 8 Vink R, Nimmo AJ, Cernak I. An overview of new and novel pharmacotherapies for use in traumatic brain injury. Clin Exp Pharmacol Physiol 2001; 28 (11) 919-921
  • 9 Kirkland AE, Sarlo GL, Holton KF. The role of magnesium in neurological disorders. Nutrients 2018; 10 (06) 730
  • 10 Carney N, Totten AM, O'Reilly C. et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery 2017; 80 (01) 6-15
  • 11 Odusan OO, Familoni OB, Odewabi AO, Idowu AO, Adekolade AS. Patterns and correlates of serum magnesium levels in subsets of type 2 diabetes mellitus patients in Nigeria. Indian J Endocrinol Metab 2017; 21 (03) 439-442
  • 12 Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 2007; 99 (01) 18-31
  • 13 Dhandapani SS, Gupta A, Vivekanandhan S, Mahapatra AK, Mehta VS. Serum ionic magnesium in traumatic brain injury. Indian J Neurotrauma 2005; 2 (02) 103-106
  • 14 Vink R, McIntosh TK, Demediuk P, Faden AI. Decrease in total and free magnesium concentration following traumatic brain injury in rats. Biochem Biophys Res Commun 1987; 149 (02) 594-599
  • 15 Saatman KE, Bareyre FM, Grady MS, McIntosh TK. Acute cytoskeletal alterations and cell death induced by experimental brain injury are attenuated by magnesium treatment and exacerbated by magnesium deficiency. J Neuropathol Exp Neurol 2001; 60 (02) 183-194
  • 16 Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train 2001; 36 (03) 228-235
  • 17 Altura BM. Basic biochemistry and physiology of magnesium: a brief review. Magnes Trace Elem 1991-1992–1992; 10 (2–4): 167-171
  • 18 Volpe SL. Magnesium in disease prevention and overall health. Adv Nutr 2013; 4 (03) 378S-383S
  • 19 Laupland KB, Tabah A, Jacobs N, Ramanan M. Determinants of serum magnesium abnormalities and outcome among admissions to the intensive care unit. Anaesth Crit Care Pain Med 2020; 39 (06) 793-797
  • 20 Thongprayoon C, Cheungpasitporn W, Hansrivijit P. et al. Association of serum magnesium level change with in-hospital mortality. BMJ Evid Based Med 2020; 25 (06) 206-212
  • 21 Han X, You S, Huang Z. et al. Prognostic significance of serum magnesium in acute intracerebral hemorrhage patients. Curr Neurovasc Res 2019; 16 (02) 123-128
  • 22 Goyal N, Tsivgoulis G, Malhotra K. et al. Serum magnesium levels and outcomes in patients with acute spontaneous intracerebral hemorrhage. J Am Heart Assoc 2018; 7 (08) e008698
  • 23 Liotta EM, Prabhakaran S, Sangha RS. et al. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 2017; 89 (08) 813-819
  • 24 Feng P, Niu X, Hu J. et al. Relationship of serum magnesium concentration to risk of short-term outcome of acute ischemic stroke. Blood Press 2013; 22 (05) 297-301
  • 25 You S, Zhong C, Du H. et al. Admission low magnesium level is associated with in-hospital mortality in acute ischemic stroke patients. Cerebrovasc Dis 2017; 44 (1–2): 35-42
  • 26 Pin-On P, Saringkarinkul A, Punjasawadwong Y, Kacha S, Wilairat D. Serum electrolyte imbalance and prognostic factors of postoperative death in adult traumatic brain injury patients: a prospective cohort study. Medicine (Baltimore) 2018; 97 (45) e13081
  • 27 Dey S, Kumar R, Tarat A. Evaluation of electrolyte imbalance in patients with traumatic brain injury admitted in the central ICU of a tertiary care centre: a prospective observational study. Cureus 2021; 13 (08) e17517
  • 28 Wang R, He M, Xu J. Initial serum magnesium level is associated with mortality risk in traumatic brain injury patients. Nutrients 2022; 14 (19) 4174
  • 29 Nayak R, Attry S, Ghosh SN. Serum magnesium as a marker of neurological outcome in severe traumatic brain injury patients. Asian J Neurosurg 2018; 13 (03) 685-688
  • 30 Stippler M, Fischer MR, Puccio AM. et al. Serum and cerebrospinal fluid magnesium in severe traumatic brain injury outcome. J Neurotrauma 2007; 24 (08) 1347-1354
  • 31 Dhandapani SS, Gupta A, Vivekanandhan S, Sharma BS, Mahapatra AK. Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury. Indian J Neurotrauma 2008; 5 (01) 27-33
  • 32 Temkin NR, Anderson GD, Winn HR. et al. Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. Lancet Neurol 2007; 6 (01) 29-38