Magnesium disturbances in critically ill children

Magnesium disturbances in critically ill children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Magnesium disturbances in critically ill children Selma Amar, Sofía Martín, Santiago Rodríguez-Tubio, Claudia Olalla, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5940557/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 May, 2025 Read the published version in Scientific Reports → Version 1 posted 6 You are reading this latest preprint version Abstract Background : To analyse the prevalence of magnesium disturbances in children admitted to the Paediatric Intensive Care Unit (PICU) and its relationship with complications and mortality. Methods : single-center, observational, retrospective study. Children with measured serum magnesium levels were included. Clinical, analytical, treatment data, clinical severity scores (Functional Status Scale, Paediatric Risk of Mortality, Paediatric Logistic Organ Dysfunction and Paediatric Multiple Organ Dysfunction Score) at admission and during PICU admission, mortality and duration of admission were recorded. Results : a cohort of 200 children (57% male) with a median age of 55 months (interquartile range 8 months to 11 years) were included. Six children (3%) presented initial hypomagnesemia and 26 (13%) presented hypomagnesemia during admission. Hypomagnesemia during admission was significantly associated with the presence of acute kidney injury (AKI) (p=0.038), shock (p=0.003), and extracorporeal membrane oxygenation (ECMO) (p=0.046). Patients with hypomagnesemia had a higher mortality (15.4% versus 1.7%) (p=0.006). 64 children (32%) presented initial hypermagnesemia, and 89 (44.5%) presented hypermagnesemia during admission . Hypermagnesemia during admission was significantly associated with heart surgery (p<0.001), without significant differences in mortality (p=0.702). Conclusions : Hypomagnesemia and hypermagnesemia are common among children admitted to the PICU. Hypomagnesemia during admission was associated with AKI, shock, ECMO and mortality. Hypermagnesemia during admission was associated with cardiac surgery but not with mortality. Health sciences/Diseases Health sciences/Medical research Health sciences/Nephrology hypomagnesemia hypermagnesemia shock mechanical ventilation acute kidney injury cardiac surgery Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Magnesium is as an essential cofactor in several critical enzymatic reactions. Alterations in magnesium affect neuromuscular, cardiovascular, respiratory and metabolic functions [ 1 – 3 ]. Hypomagnesemia has a prevalence of up to 65% in critically ill patients [ 4 – 6 ]. In some studies, hypomagnesemia has been associated with increased mortality[ 4 , 7 – 10 ], but other studies have not observed this relationship [ 11 – 13 ]. An association has also been found between hypomagnesemia, sepsis, the need for mechanical ventilation, and an increase in the time spent in the intensive care unit (ICU) [ 4 , 6 , 13 ]. However, most studies have been conducted on adult patients. Hypermagnesemia is less common than hypomagnesemia in critically ill patients [ 5 , 7 ]. Some studies have linked hypermagnesemia with increased mortality [ 4 , 7 , 14 ] and ICU admission duration [ 7 ] although the results differ among the different series [ 5 ]. Few studies that have analysed the prevalence of hypermagnesemia in critically ill children. [ 5 ]. The objective of our study was to analyse the prevalence of hypomagnesemia and hypermagnesemia in critically ill children, and its relationship with complications during admission (need for mechanical ventilation, duration of admission, renal failure, sepsis, arrhythmias, cardiorespiratory arrest) and with mortality. METHODS A single-center, retrospective, observational study was conducted. The study was approved by the Institutional Review Board (IRB), ethics and drug research committee, Hospital General Universitario Gregorio Marañón (HGUGM23/2017). Need for informed consent to participate was waived by the Institutional Review Board (IRB). Inclusion criteria: All patients admitted to the PICU between January 1st ,2021 and December 31st, 2021, were included in the study. Exclusion criteria: patients without magnesium values ​​recorded during admission to the PICU were excluded. Variables collected: The following parameters were collected: date of birth, sex, weight, reason for admission to the PICU, total time of admission to the PICU, survival and cause of death. According to our protocols, all patients were evaluated by functional state score, FSS (Functional Status Scale)[ 15 ], risk of mortality score, PRISM III (Paediatric Risk of Mortality)[ 16 ], and multiorgan dysfunction scores, PELOD2 (Paediatric Logistic Organ Dysfunction) [ 17 ] and PMODS (Paediatric Multiple Organ Dysfunction Score) [ 18 ]. Analytical values were obtained upon admission and during the stay in the PICU at the times of maximum and minimum magnesium values: magnesium (initial magnesium was the determination made in the first 24 hours of admission and the number of magnesium determinations varied depending on the patient), sodium, potassium, pH, bicarbonate, glomerular filtration rate, creatinine, and urea. Administration of drugs that can cause alterations in magnesium values: magnesium metamizole, furosemide in continuous infusion, cyclosporine or tacrolimus, lithium, vasopressors, antacids, laxatives, and enemas. Other treatments administered: nutrition (enteral, parenteral or absolute), mechanical ventilation, extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), cardiac surgery. Complications that could be related to an alteration in magnesium values: acute kidney injury (AKI), grade II or III according to the KDIGO criteria, infections (according to the CDC definitions), supraventricular or ventricular arrhythmias, shock (defined as peripheral persistent hypoperfusion with or with hypotension that required volume expansion and/or vasoactive treatment), cardiorespiratory arrest, paralytic ileus. Treatments administered to correct hypermagnesemia or hypomagnesemia during admission. Definitions of hypomagnesemia and hypermagnesemia: hypomagnesemia was defined as a magnesium value 2.5 mg/dl (1.02 mmol/L). Statistical analysis: The recorded data were analysed using the statistical package IBM SPSS 26.0 (IBM corp, Armonk, NY). Continuous quantitative variables are expressed as median and interquartile range. Missing values for the analysed variables were handled using the available-case deletion method. The qualitative variables were compared using the chi-squared test and the Fisher test. The quantitative variables were compared with the non-parametric Wilcoxon and Mann-Whitney U tests. To assess the effect of the factors on the serum magnesium disorders, different analysis models were designed using multivariate logistic regression. The variables for which a statistical association was identified in the univariate analysis were included in these models. Those variables for which the existence of collinearity was considered were excluded from this analysis. For all statistical studies carried out, a value of p < 0.05 was considered significant. RESULTS General characteristics of the patients included in the study: During the study period, 327 patients were admitted to the PICU, of these, 127 lacked recorded magnesium values. 200 patients were included in the analysis. The median age was 55 months with an interquartile range (IQR) of 8.2-136.6 months. 57% were men and 43% were women. The median weight was 16.4 kg (IQR 8.3-33 kg). Figure 1 shows the causes for admission of patients. 46.5% of patients were admitted after cardiac surgery. 199 patients (99.5%) had their first blood test taken between the first and fourth day of admission and only 1 of them (0.5%) had it taken on day 11 of admission. Hypomagnesemia in the initial analysis The median Mg levels in the first analysis was 2.3 mg/dl (IQR 2 - 2.6 mg/dl). 6/200 patients (3%) presented hypomagnesemia in the first blood test performed during their admission to the PICU. Of them, 2 patients had ARF during admission, 3 had shock and one had paralytic ileus. The incidence of shock was significantly higher among patients with initial hypomagnesemia than in the rest of the patients. There was no statistically significant relationship between hypomagnesemia in the first analysis and any treatment received or with other clinical complications throughout admission (Table 1). One of the 6 patients with hypomagnesemia on admission to the ICU (16.6%) and 5 of the 194 patients without hypomagnesemia (2.5%) died (p=0.195). Patients with hypomagnesemia in the initial analysis had higher PRISM III scores than those who did not presented hypomagnesemia, although the differences did not reach statistical significance (p=0.051). There were no significant differences in the other parameters. Hypomagnesemia during PICU stay 26/200 patients (13%) presented hypomagnesemia during their stay in the PICU. Two patients had hypomagnesemia and hypermagnesemia during their stay. In 90% of the patients, the lowest magnesium value were observed within the first 7 days of admission to the PICU. The comparison between patients with and without hypomagnesemia during admission is summarized in Table 1. Patients with hypomagnesemia more frequently presented AKI, shock, paralytic ileus, mechanical ventilation, ECMO, continuous renal replacement therapy (CRRT), and treatment with vasopressors and furosemide. The mortality rate of patients with hypomagnesemia was significantly higher (15.4%) than that of patients without it (1.7%) (p=0.006). The relationship between hypomagnesemia during admission and the severity of illness scores, age, weight, and duration of admission is shown in figure 2. Patients who presented hypomagnesemia had significantly higher PRISM III, PELOD-2, and P-MODS scores than those who did not present it, as well as a longer duration of admission. To analyse the effect of the different factors on the appearance of hypomagnesemia throughout admission, a multivariate analysis model was performed using logistic regression. Hypomagnesemia was more frequent in patients with acute kidney injury (OR 4.8; CI 1.1-20.9; p=0.038), shock (OR 36.7; CI 3.5-390.9; p=0.003), and in those who required ECMO (OR 15.8; CI 1-240.4; p=0.046) (Table 2). Hypermagnesemia in the initial analysis 64/200 patients (32%) presented hypermagnesemia in the first analysis performed in the PICU. Of them, 46/64 patients (71.9%) were admitted in the postoperative period of cardiac surgery, and this diagnosis was significantly associated with initial hypermagnesemia (Table 3). In addition, patients with hypermagnesemia in the first analysis were more frequently treated with magnesium metamizole. The incidence of shock was significantly lower among patients with initial hypermagnesemia than in the rest of the patients. There was no statistically significant relationship between hypermagnesemia in the first analysis with the rest of the treatments received or with other clinical complications throughout admission (Table 3). None of the patients who presented hypermagnesemia on admission died. The relationship between initial hypermagnesemia and severity of illness scores, age, and duration of admission is shown in figure 3. Children with hypermagnesemia at admission were younger and had a lower weight; however, the differences did not reach statistical significance. Table 4 compares the serum magnesium values at admission among patients undergoing heart surgery depending on the cardioplegia fluids used. Hypermagnesemia during PICU stay Elevated magnesium levels were observed at some point during admission to the PICU in 89/200 (44.5%) of the patients studied. Of the 200 patients, 91% had the highest magnesium value in the first 7 days of admission. The median Mg level in the analysis with the highest magnesium value was 2.4 mg/dl (IQR 2.1-2.7 mg/dl). A significantly higher percentage of patients with hypermagnesemia underwent heart surgery (71.9%) than patients without hypermagnesemia (27%) p<0.001. Patients who developed hypermagnesemia during admission were more frequently treated with ECMO, magnesium metamizole, furosemide in continuous infusion, and vasopressors than patients without hypermagnesemia. There were no significant differences in mortality (table 3). Figure 3 shows the relationship between hypermagnesemia during PICU admission and severity of illness scores, age, and duration of admission. Patients with hypermagnesemia had significantly higher PELOD-2 scores than patients without it. To determine the influence of the factors analysed on the appearance of hypermagnesemia during admission, an analysis was performed using multivariate logistic regression. Hypermagnesemia was independently associated with heart surgery (OR 6.5; CI 3.1-13.8; p<0.001). No association was found with other variables (Table 2). DISCUSSION Our study revealed that hypomagnesemia and hypermagnesemia were common alterations in children admitted to the PICU, with hypermagnesemia being more common, affecting almost half of the patients (44.5%). Hypomagnesemia was associated with AKI, shock, ECMO, and mortality. Hypermagnesemia was associated with cardiac surgery. Hypomagnesemia The incidence of hypomagnesemia in our study was similar to that reported by Verive et al. [19], but lower than that found in other studies [4-6,20]. The most common causes of hypomagnesemia in critically ill patients are digestive malabsorption, sepsis, extracorporeal circulation, kidney disease, diabetic ketoacidosis, and treatment with drugs, such as diuretics, cyclosporine, and insulin[5]. The clinical manifestations of hypomagnesemia include muscle weakness, respiratory failure, and arrhythmias [3,4,6,21]. Several studies have described the relationship between hypomagnesemia and increased complications and mortality in critically ill adult and paediatric patients [4-7,21,22]. In our study we separately analysed hypomagnesemia in the initial analysis upon admission to the PICU, and hypomagnesemia developed throughout the PICU stay. No relationship was found between hypomagnesemia on admission with mortality or duration of admission to the PICU, but there was a greater frequency of shock, although we cannot establish whether hypomagnesemia favours the appearance of shock or if patients with shock present more frequently. On the contrary, patients who presented hypomagnesemia at some point during PICU admission had a higher mortality rate, as has been found in other studies on critically ill adults and children [4,6,7,21-23]. Moreover, there was an association between hypomagnesemia throughout admission, the appearance of AKI, paralytic ileus, shock, and with CRRT and ECMO. Due to the study design, it was not possible to determine whether these associations imply causality. As found in other studies in children, there was no relationship between hypomagnesemia and the development of arrhythmias[12], a fact that has been described in several studies in adults [21,24]. Several authors have described a higher incidence of hypomagnesemia in the postoperative period of heart surgery, both in adults[21] and children [12]. On the other hand, in our study we did not objectify this relationship. On the contrary, in our study, these patients had higher magnesium values. This fact could be related to the composition of the cardioplegia solutions used during heart surgery. In a previous study conducted by our group, it was observed that patients who had received cardioplegic solutions without magnesium had a high incidence of hypomagnesemia, whereas those who received cardioplegic solutions with magnesium, had significantly higher postoperative serum magnesium concentrations [12]. In our centre, three different cardioplegic solutions containing magnesium are currently used: Celsior© (13 mmol/L), Custodiol© (4 mmol/L), and Pedro del Nido solution © (6.2 mmol/L). As expected, serum magnesium values were higher in patients treated with the solution with the highest concentration of magnesium. In several studies and meta-analyses on adult patients, a relationship has been found between hypomagnesemia and the need for mechanical ventilation [4,6]. In our study, mechanical ventilation was significantly more frequent in children with hypomagnesemia (73.1%) than in those without hypomagnesemia (43.1%). It is also not possible to define whether there is causality in this relationship. Patients with hypomagnesemia received continuous furosemide infusion (which produces increased urinary losses of magnesium) and vasopressors more frequently than patients who did not present hypomagnesemia. We did not find other studies that have analysed these variables. Finally, the length of admission for children with hypomagnesemia was significantly longer than for those without the condition. In some studies in adults [4,6] and children [7] hypomagnesemia was related to longer ICU admission times, whereas others have found no significant differences [5,12]. On the other hand, patients with hypomagnesemia had greater clinical severity with significantly higher PRISM III, PELOD-2, and P-MODS scores. Therefore, hypomagnesemia during admission to the PICU is related to severe complications, higher mortality, and longer duration of admission to the PICU. Although causal relationships cannot be established from our data, hypomagnesemia may be an indicator of illness severity and complicated evolution and supports the need for periodic controls of this element. Alterations in other biochemical parameters such as albumin [26], lactate [27], lactate/albumin ratio [28], calcium [29], phosphorus [30], and chloride[31] are also associated with the prognosis of critically ill adults and children, and they can also be used as markers of illness severity or risk of mortality. Hypermagnesemia In our study, hypermagnesemia was the most frequent alteration in serum magnesium levels, affecting 32% of patients in the initial analysis and 44.5% throughout admission to the PICU. This incidence is higher than that described in other studies [8,9]. This high incidence may be because our series includes a high proportion of patients (46.5%) who were admitted to the PICU after heart surgery and could be related to the cardioplegia solutions used [12] . The most common causes of hypermagnesemia in the PICU are antacids administration, parenteral nutrition, hypothermia, and AKI. [5]. However, our study did not find an association between hypermagnesemia and AKI. In several adult studies, hypermagnesemia was correlated to mortality and duration of ICU admission[7,14]. However, in our study, patients with initial hypermagnesemia, or developed at some point during their admission, did not have higher mortality or longer admission to the PICU. Treatment with vasopressors and furosemide was significantly more frequent in patients with hypermagnesemia. It is possible that this relationship is due to the fact that these treatments are more frequent during the postoperative period of heart surgery. We did not find other studies that analyse these variables either. Hypermagnesemia was correlated with magnesium metamizole treatment. Metamizole is presented as metamizole magnesium 2 g/5 ml and the amount of magnesium ranges between 60 and 70 mg (5-6 mEq) [25]. Considering that the recommended daily dose of magnesium in children is 75-410 mg of magnesium and that enteral and parenteral nutrition also contain magnesium, it is possible that this drug contributed to the development of hypermagnesemia in some patients. Our study has several limitations. First, this was a retrospective study of a heterogeneous population of patients with a limited sample size and referred to a single hospital, so the results could not be extrapolated to other centers. Nearly half of the patients were in the postoperative period of cardiac surgery, and as we have previously commented, this may have increased the incidence of magnesium abnormalities in our study compared with other PICUs. Our study does not allow us to establish a causal relationship between magnesium levels and the rest of the parameters, only allowing us to establish a statistical association between the presence of magnesium alterations and the appearance of certain clinical evolution variables. It must be considered that it is difficult to evaluate hypomagnesemia and hypermagnesemia in isolation because they often occur in the context of other electrolytic alterations (calcium, potassium, phosphorus) that can influence magnesium levels [19]. Regarding treatments such as diuretics, we did not analyse the relationship between the dose and timing of diuretic treatment and the onset of hypomagnesemia. We only analysed whether there was an association with the development of hypomagnesemia after admission to the ICU. We also did not analyse the relationship between the nutritional intake and the development of magnesium abnormalities. On the other hand, total magnesium levels measured in plasma do not reflect intracellular magnesium content or ionized magnesium in blood, which are those that are related to physiological functions and could be better associated with complications and clinical evolution [7,12,19,22]. A recent studied in critically ill children found higher red blood cell concentrations than in plasma [32]. Conclusions Hypomagnesemia and hypermagnesemia were common in children admitted to the PICU. Hypomagnesemia during admission was associated with AKI, shock, and ECMO. Patients with hypomagnesemia during PICU admission exhibited significantly higher mortality. Hypermagnesemia during admission was associated with cardiac surgery but not with mortality or length of PICU stay. The importance of our study is to highlight the frequency of magnesium abnormalities in critically ill children and the conditions with which they are most associated, so that clinicians can diagnose and treat them early. Abbreviations AKI: acute kidney injury CI: confidence interval CRRT: continuous renal replacement therapy ECMO: extracorporeal membrane oxygenation FSS: Functional Status Scale ICU: Intensive Care Unit IQR: interquartile range OR: Odds ratio PELOD: Paediatric Logistic Organ Dysfunction PICU: Paediatric Intensive Care Unit P-MODS: Paediatric Multiple Organ Dysfunction Score PRISM: Paediatric Risk of Mortality Declarations DATA AVAILABILITY STATEMENT The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request. AUTHORS CONTRIBUTION SA, SM, SRT, CO, CDA: Data collection and analysis, bibliographic search and analysis, and writing and revision of the text. JAZ, RP, BR: Data collection, analysis and revision of the text. JLH, RG: design and direction of the study, analysis and interpretation of the data, and writing and revision of the text. ADDITIONAL INFORMATION Competing interests statement: All authors declare no financial or non-financial conflicts of interest regarding this study. Funding statement: No funding was received for this study. Ethics statement: The study was approved by Gregorio Marañón General University Hospital Institutional Review Board (HGUGM23/2017). All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. References Baaij, J.H.F. de, Hoenderop, J.G.J., Bindels, R.J.M. Magnesium in Man: Implications for Health and Disease. Physiol Rev 95 :1-46. (2015). https://doi.org/10.1152/physrev.00012.2014. Ahmed, F., Mohammed, A. Magnesium: The Forgotten Electrolyte—A Review on Hypomagnesemia. Méd Sci 7 :56. (2019) https://doi.org/10.3390/medsci7040056. Sagar, A.N., Kalburgi. V., Vagha, J.D., Taksande, A., Meshram, R.J., Lohiya, S. A Comprehensive Review of the Role of Magnesium in Critical Care Pediatrics: Mechanisms, Clinical Impact, and Therapeutic Strategies. Cureus. 16 (8):e66643 (2024) https://doi.org/10.7759/cureus.66643. Upala, S., Jaruvongvanich, V., Wijarnpreecha, K., Sanguankeo, A. Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis. QJM: Int J Med 109: 453–459. (2016). https://doi.org/10.1093/qjmed/hcw048. Magro, P.R., López, C.A., López-Herce, J., Campos, M.M., Pérez, L.S. [Metabolic changes in critically ill children]. An Esp Pediatr 51:143–148 (1999) Jiang, P., Lv, Q., Lai, T., Xu, F. Does Hypomagnesemia Impact on the Outcome of Patients Admitted to the Intensive Care Unit; A Systematic Review and Meta-Analysis. Shock 47 :288–295 (2017) https://doi.org/10.1097/shk.0000000000000769. Singhi, S.C., Singh, J., Prasad, R. Hypo‐ and Hypermagnesemia in an Indian Pediatric Intensive Care Unit. J Trop Pediatr 49 :99-103(2003). https://doi.org/10.1093/tropej/49.2.99. Dandinavar, S,F,, Suma, D,, Ratageri, V,H,, Wari, P,K. Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome. Int J Contemp Pediatr. 6 :462–467(2019). https://doi.org/10.18203/2349-3291.ijcp20190228. Yue, C.Y. , Zhang, C.Y., Huang, Z.L., Ying, C.M. A Novel U-Shaped Association Between Serum Magnesium on Admission and 28-Day In-hospital All-Cause Mortality in the Pediatric Intensive Care Unit. Front Nutr. 9 :747035(2022). https://doi.org/10.3389/fnut.2022.747035. Morooka, H., Tanaka, A., Kasugai, D., Ozaki, M., Numaguchi, A., Maruyama. S. Abnormal magnesium levels and their impact on death and acute kidney injury in critically ill children. Pediatr Nephrol. 37 (5):1157-1165. (2022) https://doi.org/10.1007/s00467-021-05331-1. Saleem, A.F., Haque, A. On admission hypomagnesemia in critically ill children: Risk factors and outcome. Indian J Pediatr 76 :1227–1230. (2009) https://doi.org/10.1007/s12098-009-0258-z. Mencía, S., De Lucas, N., López-Herce, J., Muñoz, R., Carrillo, A., Garrido, G. Magnesium metabolism after cardiac surgery in children. Pediatr Crit Care Med 3 :158–166 (2002) . https://doi.org/10.1097/00130478-200204000-00013. Wang, H., Huang, J., Jin, X., Chen, C., Zhang, A., Wu, Y,, Chen, C. Hypermagnesaemia, but Not Hypomagnesaemia, Is a Predictor of Inpatient Mortality in Critically Ill Children with Sepsis. Dis Markers. 2022 :3893653. (2022); https://doi.org/10.1155/2022/3893653. Broner, C.W., Stidham, G.L., Westenkirchner, D.F., Tolley, E.A. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients. Crit Care Med 18 :921–8. (1990) https://doi.org/10.1097/00003246-199009000-00004. Pollack, M.M., Holubkov, R., Glass, P., Dean, J.M., Meert, K.L., Zimmerman, J., et al. Functional Status Scale: New Pediatric Outcome Measure. Pediatrics 124 :e18–28. (2009) https://doi.org/10.1542/peds.2008-1987. Ruttimann, U.E., Pollack, M.M., Patel, K.M. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 24 :743–752(1996). https://doi.org/10.1097/00003246-199605000-00004. Leteurtre, S., Duhamel, A., Salleron, J., Grandbastien, B., Lacroix, J., Leclerc, F., et al. PELOD-2: an update of the Pediatric logistic organ dysfunction score. Crit Care Med 41 :1761-1773. (2013) https://doi.org/10.1097/ccm.0b013e31828a2bbd. Graciano, A.L., Balko, J.A., Rahn, D.S., Ahmad, N., Giroir, B.P. The Pediatric Multiple Organ Dysfunction Score (P-MODS); Development and validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children. Crit Care Med 33 :1484–1491(2005). https://doi.org/10.1097/01.ccm.0000170943.23633.47. Verive, M.J., Irazuzta, J., Steinhart, C.M., Orlowski, J.P., Jaimovich ,D.G. Evaluating the frequency rate of hypomagnesemia in critically ill pediatric patients by using multiple regression analysis and a computer-based neural network. Crit Care Med 28 :3534–3539 (2000). https://doi.org/10.1097/00003246-200010000-00031. Panahi, Y., Mojtahedzadeh, M., Najafi, A., Ghaini, M.R., Abdollahi, M., Sharifzadeh, M., et al. The role of magnesium sulfate in the intensive care unit. EXCLI J 16 :464–82 (2017). https://doi.org/10.17179/excli2017-182. Hansen, B-A., Bruserud, Ø. Hypomagnesemia in critically ill patients. J Intensive Care 6 :21(2018). https://doi.org/10.1186/s40560-018-0291-y. Sedlacek, M., Schoolwerth, A.C., Remillard, B.D. Electrolyte Disturbances in the Intensive Care Unit. Semin Dial 19 :496–501(2006). https://doi.org/10.1111/j.1525-139x.2006.00212.x. Fairley, J., Glassford, N.J., Zhang, L., Bellomo, R. Magnesium status and magnesium therapy in critically ill patients: A systematic review. J Crit Care 30 :1349–1358. (2015) https://doi.org/10.1016/j.jcrc.2015.07.029. England, M.R., Gordon, G., Salem, M., Chernow, B. Magnesium Administration and Dysrhythmias After Cardiac Surgery: A Placebo-Controlled, Double-blind, Randomized Trial. JAMA ; 268 :2395-2402(1992). https://doi.org/10.1001/jama.1992.03490170067027. de Sevilla, M.Á.C.F, Úbeda, M.G., Lugea, A.E., Gómez, F.T. Magnesium in drugs: do we have enough information?. Farm Hosp 38 :494–495 (2014). https://doi.org/10.7399/fh.2014.38.6.8017. Ari, H.F., Turanli, E.E., Yavuz, S., Guvenc ,K., Avci, A., Keskin, A., Aslan, N., Yildizdas, D. Association between serum albumin levels at admission and clinical outcomes in pediatric intensive care units: a multi-center study. BMC Pediatr 24 :844 (2024). https://doi.org/10.1186/s12887-024-05331-8 Wang, Y., Wu, Q., Zhu, X., Wu, X., Zhu, P.. Lactate levels and the modified age-adjusted quick sequential organ failure assessment (qSOFA) score are fair predictors of mortality in critically ill pediatric patients. Am J Emerg Med. 92 :85-90 (2025). https://doi.org/10.1016/j.ajem.2025.03.010. Arı, H. F., Keskin, A., Arı, M., Aci, R.. Importance of Lactate/Albumin Ratio in Pediatric Nosocomial Infection and Mortality at Different Times. Future Microbiology, 19 :51–59. (2023) https://doi.org/10.2217/fmb-2023-0125 Wang, B., Gong, Y., Ying, B., Cheng, B. Association of Initial Serum Total Calcium Concentration with Mortality in Critical Illness. Biomed Res Int . 2018 :7648506. (2018) https://doi.org/10.1155/2018/7648506. Barhight, M.F., Brinton, J., Stidham, T., Soranno, D.E., Faubel, S., Griffin, B.R., Goebel, J., Mourani, P.M., Gist, K.M. Increase in chloride from baseline is independently associated with mortality in critically ill children. Intensive Care Med . 44 :2183-2191(2018). https://doi.org/10.1007/s00134-018-5424-1. Zhou,X., He, J., Zhu, D., Yao, Z., Peng, D., Zhang, X. Relationship between serum phosphate and mortality in critically ill children receiving continuous renal replacement therapy. Front Pediatr. 11 :1129156. (2023) https://doi.org/10.3389/fped.2023.1129156. Veldscholte, K., Al Fify, M., Catchpole, A., Talwar, D., Wadsworth, J., Vanhorebeek, I., Casaer, M.P., Van den Berghe, G., Joosten, K.F.M., Gerasimidis, K., Verbruggen, S.C.A.T. Plasma and red blood cell concentrations of zinc, copper, selenium and magnesium in the first week of paediatric critical illness. Clin Nutr. 43 :543-551 (2024). https://doi.org/10.1016/j.clnu.2024.01.004. Tables Table 1. Comparison between patients with hypomagnesemia and those who did not in relation to treatments, complications and mortality. Hypomagnesemia in the first analysis Hypomagnesemia at some time during PICU stay Yes (N=6) No (N=194) p Yes (N=26) No (N=174) p % (n/N) % (n/N) % (n/N) % (n/N) Sex (male) 33.3% (2/6) 57.7% (112/194) 0.405 53.8% (14/26) 57.5% (100/174) 0.782 AKI 33.3% (2/6) 10.3% (20/194) 0.132 42.3% (11/26) 6.3% (11/174) <0.001 CRRT 16.7% (1/6) 4.1% (8/194) 0.244 23.1% (6/26) 1.7% (3/174) <0.001 Cardiac arrest 0% (0/6) 2.1% (4/194) 1 7.7% (2/26) 1.1% (2/174) 0.083 Arrhythmia 16.7% (1/6) 8.2% (16/194) 0.417 11.5% (3/26) 8% (14/174) 0.469 Shock 50.0% (3/6) 3.6% (7/194) 0.002 30.8% (8/26) 1.1% (2/174) <0.001 Mechanical ventilation 66.7% (4/6) 46.4% (90/194) 0.423 73.1% (19/26) 43.1% (75/174) 0.004 ECMO 16.7% (1/6) 3.1% (6/194) 0.195 23.1% (6/26) 0.6% (1/174) <0.001 Heart surgery 16.7% (1/6) 47.9% (93/194) 0.217 38.5 % (10/26) 48.3% (84/174) 0.35 Paralytic ileus 16.7% (1/6) 1% (2/194) 0.088 7.7% (2/26) 0.6% (1/174) 0.045 Magnesium metamizole administration 33.3% (2/6) 55.2% (107/194) 0.414 46.2% (12/26) 55.7% (97/174) 0.36 Furosemide (continuous infusion) 83.3% (5/6) 41.8% (81/194) 0.086 65.4% (17/26) 39.7% (69/174) 0.013 Vasoactive drugs 50% (3/6) 32% (62/194) 0.393 50% (13/26) 29.9% (52/174) 0.041 Mortality 16.7% (1/6) 3.1% (6/194) 0.195 15.4% (4/26) 1.7% (3/174) 0.006 AKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation. CRRT: Continuous Renal Replacement Therapy Table 2. Multivariate analysis of factors associated with magnesium disturbances at some time during admission. Hypomagnesemia OR 95% C.I. OR p Lower AKI 4.8 1.1 0.038 CRRT 2.7 0.3 0.373 Cardiac arrest 0.1 0 0.246 Shock 36.7 3.5 0.003 Mechanical ventilation 1.3 0.4 0.696 ECMO 15.8 1 0.046 Furosemide (continuous infusion) 1.3 0.4 0.685 Vasoactive drugs 1 0.3 0.989 Hypermagnesemia OR 95% C.I. OR p Lower CRRT 4.6 0.7 0.108 ECMO 4.6 0.4 0.228 Heart Surgery 6.5 3.1 <0.001 Magnesium metamizole 1.1 0.6 0.739 Furosemide (continuous infusion) 1.3 0.7 0.406 Vasoactive drugs 0.8 0.4 0.623 AKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation. CRRT: Continuous Renal Replacement Therapy Table 3. Hypermagnesemia in relation to treatment, complications and mortality. Hypermagnesemia in the first analysis Hypermagnesemia at some time during PICU stay Yes (N=64) No (N=136) p Yes (N=89) No (N=111) p % (n/N) % (n/N) % (n/N) % (n/N) Sex (male) 56.3% (36/64) 57.4% (78/136) 0.883 57.3% (51/89) 56.8% (63/111) 0.938 AKI 9.4% (6/64) 11.8% (16/136) 0.614 14.6% (13/89) 8.1% (9/111) 0.144 CRRT 4.7% (3/64) 4.4 (6/136) 1 7.8% (7/89) 1.8% (2/111) 0.093 Cardiac Arrest 0% (0/64) 2.9% (4/136) 0.308 1.1% (1/89) 2.7% (3/111) 0.63 Arrhythmia 4.7% (3/64) 10.3% (14/136) 0.277 9% (8/89) 8.1% (9/111) 0.824 Shock 0% (0/64) 7.4% (10/136) 0.032 3.4% (3/89) 6.3% (7/111) 0.517 Mechanical ventilation 43.8% (28/64) 48.5% (66/136) 0.528 52.8% (47/89) 42.3% (47/111) 0.141 ECMO 0% (0/64) 5.1% (7/136) 0.099 6.7% (6/89) 0.9% (1/111) 0.046 Heart surgery 71.9% (46/64) 35.3% (48/136) <0.001 71.9% (64/89) 27% (30/111) <0.001 Paralytic ileus 0% (0/64) 2.2% (3/136) 0.553 2.2% (2/89) 0.9% (1/111) 0.586 Administration of Magnesium metamizole 68.8% (44/64) 47.8% (65/136) 0.006 66.3% (59/89) 45% (50/111) 0.003 Furosemide (continuous infusion) 50% (32/64) 39.7% (54/136) 0.17 55.1% (49/89) 33.3% (37/111) 0.002 Vasoactive drugs 35.9% (23/64) 30.9% (42/136) 0.476 40.4% (36/89) 26.1% (29/111) 0.032 Mortality 0% (0/64) 5.1% (7/136) 0.099 4.5% (4/89) 2.7% (3/111) 0.702 AKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation. CRRT: Continuous Renal Replacement Therapy Table 4. Comparison of magnesium serum values at admission among patients undergoing heart surgery according to the cardioplegic solution used. No cardioplegy (n=10) Celsior R (n=43) Custodiol R (n=6) Pedro del Nido R (n=17) p Magnesium (mg/dl) 2.2 (2.3-2.5) 2.9 (2.5-3.6) 2.1 (1.9-2.6) 2.2 (2.1-2.5) <0.001 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 12 May, 2025 Reviews received at journal 28 Apr, 2025 Reviewers agreed at journal 25 Apr, 2025 Reviewers invited by journal 25 Apr, 2025 Submission checks completed at journal 25 Apr, 2025 First submitted to journal 24 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5940557","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":449069274,"identity":"936739b0-8498-49f6-937b-611ec91ebeb0","order_by":0,"name":"Selma Amar","email":"","orcid":"","institution":"Complutense University of Madrid","correspondingAuthor":false,"prefix":"","firstName":"Selma","middleName":"","lastName":"Amar","suffix":""},{"id":449069275,"identity":"597cc27f-10c3-4096-a069-178d007ca496","order_by":1,"name":"Sofía Martín","email":"","orcid":"","institution":"Complutense University of Madrid","correspondingAuthor":false,"prefix":"","firstName":"Sofía","middleName":"","lastName":"Martín","suffix":""},{"id":449069276,"identity":"9b1e6d20-674a-4a01-a392-35cd3adf2b64","order_by":2,"name":"Santiago Rodríguez-Tubio","email":"","orcid":"","institution":"Gregorio Marañón General University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Santiago","middleName":"","lastName":"Rodríguez-Tubio","suffix":""},{"id":449069277,"identity":"7b7bfbf6-2089-4338-a9ca-3560be80d072","order_by":3,"name":"Claudia Olalla","email":"","orcid":"","institution":"Gregorio Marañón General University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Olalla","suffix":""},{"id":449069278,"identity":"52aff823-cf7e-4232-8a59-33c2a5ab2532","order_by":4,"name":"Cristina De Angeles","email":"","orcid":"","institution":"Gregorio Marañón General University 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rafael","middleName":"","lastName":"González","suffix":""}],"badges":[],"createdAt":"2025-02-01 07:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5940557/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5940557/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-02288-1","type":"published","date":"2025-05-21T15:58:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82047932,"identity":"acc3bd7d-5be3-4f33-a915-1cc2533568a0","added_by":"auto","created_at":"2025-05-06 09:44:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77977,"visible":true,"origin":"","legend":"\u003cp\u003eCauses for admission of patients in the paediatric intensive care unit.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5940557/v1/947d6a62095ed139374e38b2.png"},{"id":82047935,"identity":"fdd8b14a-3f2b-490e-9d74-1c8d8be8c02c","added_by":"auto","created_at":"2025-05-06 09:44:39","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":317553,"visible":true,"origin":"","legend":"\u003cp\u003eAge, weight, duration of admission, and clinical severity scores comparison between patients with hypomagnesemia and those who did not. (Median and interquartile range) at admission and during PICU stay.\u003c/p\u003e\n\u003cp\u003eFSS: Functional Status Scale; PRISM III: Paediatric Risk of Mortality score; PELOD-2: Paediatric logistic organ dysfunction score; PMODS: Paediatric Multiple Organ Dysfunction Score.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5940557/v1/f47418d3bc9f784296669a84.jpeg"},{"id":82047937,"identity":"a47bf80f-6c3e-4d34-aa69-335b36467f91","added_by":"auto","created_at":"2025-05-06 09:44:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":140794,"visible":true,"origin":"","legend":"\u003cp\u003eAge, weight, duration of admission, and clinical severity scores comparison between patients with hypermagnesemia and those who did not. (Median and interquartile range).\u003c/p\u003e\n\u003cp\u003eFSS: Functional Status Scale; PRISM III: Paediatric Risk of Mortality score; PELOD-2: Paediatric logistic organ dysfunction score; PMODS: Paediatric Multiple Organ Dysfunction Score.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5940557/v1/a730110807c4c1cb6fe8c93a.png"},{"id":83460207,"identity":"81cf5dcb-2ed5-4eda-a06b-a61fd374073a","added_by":"auto","created_at":"2025-05-26 16:12:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1608944,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5940557/v1/1796d50f-f7a2-4760-9130-77170d73011a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnesium disturbances in critically ill children","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMagnesium is as an essential cofactor in several critical enzymatic reactions. Alterations in magnesium affect neuromuscular, cardiovascular, respiratory and metabolic functions [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHypomagnesemia has a prevalence of up to 65% in critically ill patients [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In some studies, hypomagnesemia has been associated with increased mortality[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but other studies have not observed this relationship [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. An association has also been found between hypomagnesemia, sepsis, the need for mechanical ventilation, and an increase in the time spent in the intensive care unit (ICU) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, most studies have been conducted on adult patients.\u003c/p\u003e \u003cp\u003eHypermagnesemia is less common than hypomagnesemia in critically ill patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Some studies have linked hypermagnesemia with increased mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and ICU admission duration [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] although the results differ among the different series [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Few studies that have analysed the prevalence of hypermagnesemia in critically ill children. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of our study was to analyse the prevalence of hypomagnesemia and hypermagnesemia in critically ill children, and its relationship with complications during admission (need for mechanical ventilation, duration of admission, renal failure, sepsis, arrhythmias, cardiorespiratory arrest) and with mortality.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA single-center, retrospective, observational study was conducted. The study was approved by the Institutional Review Board (IRB), ethics and drug research committee, Hospital General Universitario Gregorio Mara\u0026ntilde;\u0026oacute;n (HGUGM23/2017). Need for informed consent to participate was waived by the Institutional Review Board (IRB).\u003c/p\u003e \u003cp\u003eInclusion criteria: All patients admitted to the PICU between January 1st ,2021 and December 31st, 2021, were included in the study. Exclusion criteria: patients without magnesium values ​​recorded during admission to the PICU were excluded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVariables collected:\u003c/h2\u003e \u003cp\u003eThe following parameters were collected: date of birth, sex, weight, reason for admission to the PICU, total time of admission to the PICU, survival and cause of death. According to our protocols, all patients were evaluated by functional state score, FSS (Functional Status Scale)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], risk of mortality score, PRISM III (Paediatric Risk of Mortality)[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and multiorgan dysfunction scores, PELOD2 (Paediatric Logistic Organ Dysfunction) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and PMODS (Paediatric Multiple Organ Dysfunction Score) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Analytical values were obtained upon admission and during the stay in the PICU at the times of maximum and minimum magnesium values: magnesium (initial magnesium was the determination made in the first 24 hours of admission and the number of magnesium determinations varied depending on the patient), sodium, potassium, pH, bicarbonate, glomerular filtration rate, creatinine, and urea. Administration of drugs that can cause alterations in magnesium values: magnesium metamizole, furosemide in continuous infusion, cyclosporine or tacrolimus, lithium, vasopressors, antacids, laxatives, and enemas. Other treatments administered: nutrition (enteral, parenteral or absolute), mechanical ventilation, extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), cardiac surgery. Complications that could be related to an alteration in magnesium values: acute kidney injury (AKI), grade II or III according to the KDIGO criteria, infections (according to the CDC definitions), supraventricular or ventricular arrhythmias, shock (defined as peripheral persistent hypoperfusion with or with hypotension that required volume expansion and/or vasoactive treatment), cardiorespiratory arrest, paralytic ileus. Treatments administered to correct hypermagnesemia or hypomagnesemia during admission.\u003c/p\u003e \u003cp\u003eDefinitions of hypomagnesemia and hypermagnesemia: hypomagnesemia was defined as a magnesium value\u0026thinsp;\u0026lt;\u0026thinsp;1.6 mg/dl (0.65 mmol/L) and hypermagnesemia as a magnesium value\u0026thinsp;\u0026gt;\u0026thinsp;2.5 mg/dl (1.02 mmol/L).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe recorded data were analysed using the statistical package IBM SPSS 26.0 (IBM corp, Armonk, NY). Continuous quantitative variables are expressed as median and interquartile range. Missing values for the analysed variables were handled using the available-case deletion method. The qualitative variables were compared using the chi-squared test and the Fisher test. The quantitative variables were compared with the non-parametric Wilcoxon and Mann-Whitney U tests. To assess the effect of the factors on the serum magnesium disorders, different analysis models were designed using multivariate logistic regression. The variables for which a statistical association was identified in the univariate analysis were included in these models. Those variables for which the existence of collinearity was considered were excluded from this analysis. For all statistical studies carried out, a value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics of the patients included in the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, 327 patients were admitted to the PICU, of these, 127 lacked recorded magnesium values. 200 patients were included in the analysis. The median age was 55 months with an interquartile range (IQR) of 8.2-136.6 months. 57% were men and 43% were women. The median weight was 16.4 kg (IQR 8.3-33 kg). \u0026nbsp;Figure 1 shows the causes for admission of patients. 46.5% of patients were admitted after cardiac surgery. 199 patients (99.5%) had their first blood test taken between the first and fourth day of admission and only 1 of them (0.5%) had it taken on day 11 of admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypomagnesemia in the initial analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median Mg levels in the first analysis was 2.3 mg/dl (IQR 2 - 2.6 mg/dl). 6/200 patients (3%) presented hypomagnesemia in the first blood test performed during their admission to the PICU. Of them, 2 patients had ARF during admission, 3 had shock and one had paralytic ileus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe incidence of shock was significantly higher among patients with initial hypomagnesemia than in the rest of the patients. There was no statistically significant relationship between hypomagnesemia in the first analysis and any treatment received or with other clinical complications throughout admission (Table 1). \u0026nbsp;One of the 6 patients with hypomagnesemia on admission to the ICU (16.6%) and 5 of the 194 patients without hypomagnesemia (2.5%) died (p=0.195).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with hypomagnesemia in the initial analysis had higher PRISM III scores than those who did not presented hypomagnesemia, although the differences did not reach statistical significance (p=0.051). There were no significant differences in the other parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypomagnesemia during PICU stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e26/200 patients (13%) presented hypomagnesemia during their stay in the PICU. Two patients had hypomagnesemia and hypermagnesemia during their stay. In 90% of the patients, the lowest magnesium value were observed within the first 7 days of admission to the PICU.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe comparison between patients with and without hypomagnesemia during admission is summarized in Table 1. Patients with hypomagnesemia more frequently presented AKI, shock, paralytic ileus, mechanical ventilation, ECMO, continuous renal replacement therapy (CRRT), and treatment with vasopressors and furosemide. The mortality rate of patients with hypomagnesemia was significantly higher (15.4%) than that of patients without it (1.7%) (p=0.006).\u003c/p\u003e\n\u003cp\u003eThe relationship between hypomagnesemia during admission and the severity of illness scores, age, weight, and duration of admission is shown in figure 2. Patients who presented hypomagnesemia had significantly higher PRISM III, PELOD-2, and P-MODS scores than those who did not present it, as well as a longer duration of admission.\u003c/p\u003e\n\u003cp\u003eTo analyse the effect of the different factors on the appearance of hypomagnesemia throughout admission, a multivariate analysis model was performed using logistic regression. Hypomagnesemia was more frequent in patients with acute kidney injury (OR 4.8; CI 1.1-20.9; p=0.038), shock (OR 36.7; CI 3.5-390.9; p=0.003), and in those who required ECMO (OR 15.8; CI 1-240.4; p=0.046) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypermagnesemia in the initial analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e64/200 patients (32%) presented hypermagnesemia in the first analysis performed in the PICU. Of them, 46/64 patients (71.9%) were admitted in the postoperative period of cardiac surgery, and this diagnosis was significantly associated with initial hypermagnesemia (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, patients with hypermagnesemia in the first analysis were more frequently treated with magnesium metamizole. The incidence of shock was significantly lower among patients with initial hypermagnesemia than in the rest of the patients. There was no statistically significant relationship between hypermagnesemia in the first analysis with the rest of the treatments received or with other clinical complications throughout admission (Table 3). None of the patients who presented hypermagnesemia on admission died.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe relationship between initial hypermagnesemia and severity of illness scores, age, and duration of admission is shown in figure 3. Children with hypermagnesemia at admission were younger and had a lower weight; however, the differences did not reach statistical significance. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 compares the serum magnesium values at admission among patients undergoing heart surgery depending on the cardioplegia fluids used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypermagnesemia during PICU stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElevated magnesium levels were observed at some point during admission to the PICU in 89/200 (44.5%) of the patients studied. Of the 200 patients, 91% had the highest magnesium value in the first 7 days of admission. The median Mg level in the analysis with the highest magnesium value was 2.4 mg/dl (IQR 2.1-2.7 mg/dl).\u003c/p\u003e\n\u003cp\u003eA significantly higher percentage of patients with hypermagnesemia underwent heart surgery (71.9%) than patients without hypermagnesemia (27%) p\u0026lt;0.001.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients who developed hypermagnesemia during admission were more frequently treated with ECMO, magnesium metamizole, furosemide in continuous infusion, and vasopressors than patients without hypermagnesemia. There were no significant differences in mortality (table 3).\u003c/p\u003e\n\u003cp\u003eFigure 3 shows the relationship between hypermagnesemia during PICU admission and severity of illness scores, age, and duration of admission. Patients with hypermagnesemia had significantly higher PELOD-2 scores than patients without it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo determine the influence of the factors analysed on the appearance of hypermagnesemia during admission, an analysis was performed using multivariate logistic regression. Hypermagnesemia was independently associated with heart surgery (OR 6.5; CI 3.1-13.8; p\u0026lt;0.001). No association was found with other variables (Table 2).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study revealed that hypomagnesemia and hypermagnesemia were common alterations in children admitted to the PICU, with hypermagnesemia being more common, affecting almost half of the patients (44.5%). Hypomagnesemia was associated with AKI, shock, ECMO, and mortality. Hypermagnesemia was associated with cardiac surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypomagnesemia\u003c/strong\u003e\u003cbr\u003eThe incidence of hypomagnesemia in our study was similar to that reported by Verive et al. [19], but lower than that found in other studies [4-6,20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most common causes of hypomagnesemia in critically ill patients are digestive malabsorption, sepsis, extracorporeal circulation, kidney disease, diabetic ketoacidosis, and treatment with drugs, such as diuretics, cyclosporine, and insulin[5]. The clinical manifestations of hypomagnesemia include muscle weakness, respiratory failure, and arrhythmias [3,4,6,21]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral studies have described the relationship between hypomagnesemia and increased complications and mortality in critically ill adult and paediatric patients [4-7,21,22]. In our study we separately analysed hypomagnesemia in the initial analysis upon admission to the PICU, and hypomagnesemia developed throughout the PICU stay. No relationship was found between hypomagnesemia on admission with mortality or duration of admission to the PICU, but there was a greater frequency of shock, although we cannot establish whether hypomagnesemia favours the appearance of shock or if patients with shock present more frequently. On the contrary, patients who presented hypomagnesemia at some point during PICU admission had a higher mortality rate, as has been found in other studies on critically ill adults and children [4,6,7,21-23]. Moreover, there was an association between hypomagnesemia throughout admission, the appearance of AKI, paralytic ileus, shock, and with CRRT and ECMO. Due to the study design, it was not possible to determine whether these associations imply causality. As found in other studies in children, there was no relationship between hypomagnesemia and the development of arrhythmias[12], a fact that has been described in several studies in adults [21,24].\u003c/p\u003e\n\u003cp\u003eSeveral authors have described a higher incidence of hypomagnesemia in the postoperative period of heart surgery, both in adults[21] and children [12]. On the other hand, in our study we did not objectify this relationship. On the contrary, in our study, these patients had higher magnesium values. This fact could be related to the composition of the cardioplegia solutions used during heart surgery. In a previous study conducted by our group, it was observed that patients who had received cardioplegic solutions without magnesium had a high incidence of hypomagnesemia, whereas those who received cardioplegic solutions with magnesium, had significantly higher postoperative serum magnesium concentrations [12]. In our centre, three different cardioplegic solutions containing magnesium are currently used: Celsior\u0026copy; (13 mmol/L), Custodiol\u0026copy; (4 mmol/L), and Pedro del Nido solution \u0026copy; (6.2 mmol/L). As expected, serum magnesium values were higher in patients treated with the solution with the highest concentration of magnesium.\u003c/p\u003e\n\u003cp\u003eIn several studies and meta-analyses on adult patients, a relationship has been found between hypomagnesemia and the need for mechanical ventilation [4,6]. In our study, mechanical ventilation was significantly more frequent in children with hypomagnesemia (73.1%) than in those without hypomagnesemia (43.1%). It is also not possible to define whether there is causality in this relationship.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with hypomagnesemia received continuous furosemide infusion (which produces increased urinary losses of magnesium) and vasopressors more frequently than patients who did not present hypomagnesemia. We did not find other studies that have analysed these variables.\u003c/p\u003e\n\u003cp\u003eFinally, the length of admission for children with hypomagnesemia was significantly longer than for those without the condition. In some studies in adults [4,6] and children\u0026nbsp;\u003cspan lang=\"EN-US\"\u003e[7]\u003c/span\u003e hypomagnesemia was related to longer ICU admission times, whereas others have found no significant differences [5,12]. On the other hand, patients with hypomagnesemia had greater clinical severity with significantly higher PRISM III, PELOD-2, and P-MODS scores.\u003c/p\u003e\n\u003cp\u003eTherefore, hypomagnesemia during admission to the PICU is related to severe complications, higher mortality, and longer duration of admission to the PICU. Although causal relationships cannot be established from our data, hypomagnesemia may be an indicator of illness severity and complicated evolution and supports the need for periodic controls of this element.\u003c/p\u003e\n\u003cp\u003eAlterations in other biochemical parameters such as albumin \u0026nbsp;[26], lactate [27], lactate/albumin ratio [28], calcium [29], phosphorus [30], and chloride[31] are also associated with the prognosis of critically ill adults and children, and they can also be used as markers of illness severity or risk of mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypermagnesemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, hypermagnesemia was the most frequent alteration in serum magnesium levels, affecting 32% of patients in the initial analysis and 44.5% throughout admission to the PICU. This incidence is higher than that described in other studies [8,9]. This high incidence may be because our series includes a high proportion of patients (46.5%) who were admitted to the PICU after heart surgery and could be related to the cardioplegia solutions used \u003cspan lang=\"EN-US\"\u003e[12]\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most common causes of hypermagnesemia in the PICU are antacids administration, parenteral nutrition, hypothermia, and AKI. [5]. However, our study did not find an association between hypermagnesemia and AKI.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn several adult studies, hypermagnesemia was correlated to mortality and duration of ICU admission[7,14]. However, in our study, patients with initial hypermagnesemia, or developed at some point during their admission, did not have higher mortality or longer admission to the PICU.\u003c/p\u003e\n\u003cp\u003eTreatment with vasopressors and furosemide was significantly more frequent in patients with hypermagnesemia. It is possible that this relationship is due to the fact that these treatments are more frequent during the postoperative period of heart surgery. We did not find other studies that analyse these variables either.\u003c/p\u003e\n\u003cp\u003eHypermagnesemia was correlated with magnesium metamizole treatment. Metamizole is presented as metamizole magnesium 2 g/5 ml and the amount of magnesium ranges between 60 and 70 mg (5-6 mEq) [25]. Considering that the recommended daily dose of magnesium in children is 75-410 mg of magnesium and that enteral and parenteral nutrition also contain magnesium, it is possible that this drug contributed to the development of hypermagnesemia in some patients.\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. First, this was a retrospective study of a heterogeneous population of patients with a limited sample size and referred to a single hospital, so the results could not be extrapolated to other centers. Nearly half of the patients were in the postoperative period of cardiac surgery, and as we have previously commented, this may have increased the incidence of magnesium abnormalities in our study compared with other PICUs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study does not allow us to establish a causal relationship between magnesium levels and the rest of the parameters, only allowing us to establish a statistical association between the presence of magnesium alterations and the appearance of certain clinical evolution variables.\u003c/p\u003e\n\u003cp\u003eIt must be considered that it is difficult to evaluate hypomagnesemia and hypermagnesemia in isolation because they often occur in the context of other electrolytic alterations (calcium, potassium, phosphorus) that can influence magnesium levels [19]. Regarding treatments such as diuretics, we did not analyse the relationship between the dose and timing of diuretic treatment and the onset of hypomagnesemia. We only analysed whether there was an association with the development of hypomagnesemia after admission to the ICU. We also did not analyse the relationship between the nutritional intake and the development of magnesium abnormalities. On the other hand, total magnesium levels measured in plasma do not reflect intracellular magnesium content or ionized magnesium in blood, which are those that are related to physiological functions and could be better associated with complications and clinical evolution [7,12,19,22]. A recent studied in critically ill children found higher red blood cell concentrations than in plasma [32]. \u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHypomagnesemia and hypermagnesemia were common in children admitted to the PICU. Hypomagnesemia during admission was associated with AKI, shock, and ECMO. Patients with hypomagnesemia during PICU admission exhibited significantly higher mortality. Hypermagnesemia during admission was associated with cardiac surgery but not with mortality or length of PICU stay. The importance of our study is to highlight the frequency of magnesium abnormalities in critically ill children and the conditions with which they are most associated, so that clinicians can diagnose and treat them early.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eAKI: acute kidney injury\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: confidence interval\u003c/p\u003e\n\u003cp\u003eCRRT: continuous renal replacement therapy\u003c/p\u003e\n\u003cp\u003eECMO: extracorporeal membrane oxygenation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFSS: Functional Status Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICU: Intensive Care Unit\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIQR: interquartile range\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u003c/p\u003e\n\u003cp\u003ePELOD: Paediatric Logistic Organ Dysfunction\u003c/p\u003e\n\u003cp\u003ePICU: Paediatric Intensive Care Unit\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP-MODS: Paediatric Multiple Organ Dysfunction Score\u003c/p\u003e\n\u003cp\u003ePRISM: Paediatric Risk of Mortality\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSA, SM, SRT, CO, CDA: Data collection and analysis, bibliographic search and analysis, and writing and revision of the text.\u003c/p\u003e\n\u003cp\u003eJAZ, RP, BR: Data collection, analysis and revision of the text.\u003c/p\u003e\n\u003cp\u003eJLH, RG: design and direction of the study, analysis and interpretation of the data, and writing and revision of the text.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eADDITIONAL INFORMATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no financial or non-financial conflicts of interest regarding this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by Gregorio Mara\u0026ntilde;\u0026oacute;n General University Hospital Institutional Review Board (HGUGM23/2017). All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaaij, J.H.F. de, Hoenderop, J.G.J., Bindels, R.J.M. Magnesium in Man: Implications for Health and Disease. \u003cem\u003ePhysiol Rev\u003c/em\u003e \u003cstrong\u003e95\u003c/strong\u003e:1-46. (2015). https://doi.org/10.1152/physrev.00012.2014.\u003c/li\u003e\n\u003cli\u003eAhmed, F., Mohammed, A. Magnesium: The Forgotten Electrolyte\u0026mdash;A Review on Hypomagnesemia. \u003cem\u003eMéd Sci\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e:56. (2019) https://doi.org/10.3390/medsci7040056.\u003c/li\u003e\n\u003cli\u003eSagar, A.N., Kalburgi. V., Vagha, J.D., Taksande, A., Meshram, R.J., Lohiya, S. A Comprehensive Review of the Role of Magnesium in Critical Care Pediatrics: Mechanisms, Clinical Impact, and Therapeutic Strategies. \u003cem\u003eCureus.\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e (8):e66643 (2024) https://doi.org/10.7759/cureus.66643.\u003c/li\u003e\n\u003cli\u003eUpala, S., Jaruvongvanich, V., Wijarnpreecha, K., Sanguankeo, A. Hypomagnesemia and mortality in patients admitted to intensive care unit: a systematic review and meta-analysis. QJM: \u003cem\u003eInt J Med\u003c/em\u003e \u003cstrong\u003e109:\u003c/strong\u003e453\u0026ndash;459. (2016). https://doi.org/10.1093/qjmed/hcw048.\u003c/li\u003e\n\u003cli\u003eMagro, P.R., L\u0026oacute;pez, C.A., L\u0026oacute;pez-Herce, J., Campos, M.M., P\u0026eacute;rez, L.S. [Metabolic changes in critically ill children]. \u003cem\u003eAn Esp Pediatr\u003c/em\u003e 51:143\u0026ndash;148 (1999)\u003c/li\u003e\n\u003cli\u003eJiang, P., Lv, Q., Lai, T., Xu, F. Does Hypomagnesemia Impact on the Outcome of Patients Admitted to the Intensive Care Unit; A Systematic Review and Meta-Analysis. \u003cem\u003eShock\u003c/em\u003e \u003cstrong\u003e47\u003c/strong\u003e:288\u0026ndash;295 (2017) https://doi.org/10.1097/shk.0000000000000769.\u003c/li\u003e\n\u003cli\u003eSinghi, S.C., Singh, J., Prasad, R. Hypo‐ and Hypermagnesemia in an Indian Pediatric Intensive Care Unit. \u003cem\u003eJ Trop Pediatr\u003c/em\u003e \u003cstrong\u003e49\u003c/strong\u003e:99-103(2003). https://doi.org/10.1093/tropej/49.2.99.\u003c/li\u003e\n\u003cli\u003eDandinavar, S,F,, Suma, D,, Ratageri, V,H,, Wari, P,K. Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome. \u003cem\u003eInt J Contemp Pediatr. \u003c/em\u003e\u003cstrong\u003e6\u003c/strong\u003e:462\u0026ndash;467(2019). https://doi.org/10.18203/2349-3291.ijcp20190228. \u003c/li\u003e\n\u003cli\u003eYue, C.Y. , Zhang, C.Y., Huang, Z.L., Ying, C.M. A Novel U-Shaped Association Between Serum Magnesium on Admission and 28-Day In-hospital All-Cause Mortality in the Pediatric Intensive Care Unit. \u003cem\u003eFront Nutr.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e:747035(2022). https://doi.org/10.3389/fnut.2022.747035. \u003c/li\u003e\n\u003cli\u003eMorooka, H., Tanaka, A., Kasugai, D., Ozaki, M., Numaguchi, A., Maruyama. S. Abnormal magnesium levels and their impact on death and acute kidney injury in critically ill children. \u003cem\u003ePediatr Nephrol.\u003c/em\u003e \u003cstrong\u003e37\u003c/strong\u003e(5):1157-1165. (2022) https://doi.org/10.1007/s00467-021-05331-1. \u003c/li\u003e\n\u003cli\u003eSaleem, A.F., Haque, A. On admission hypomagnesemia in critically ill children: Risk factors and outcome. \u003cem\u003eIndian J Pediatr\u003c/em\u003e \u003cstrong\u003e76\u003c/strong\u003e:1227\u0026ndash;1230. (2009) https://doi.org/10.1007/s12098-009-0258-z.\u003c/li\u003e\n\u003cli\u003eMenc\u0026iacute;a, S., De Lucas, N., L\u0026oacute;pez-Herce, J., Mu\u0026ntilde;oz, R., Carrillo, A., Garrido, G. Magnesium metabolism after cardiac surgery in children. \u003cem\u003ePediatr Crit Care Med\u003c/em\u003e \u003cstrong\u003e3\u003c/strong\u003e:158\u0026ndash;166 (2002) . https://doi.org/10.1097/00130478-200204000-00013.\u003c/li\u003e\n\u003cli\u003eWang, H., Huang, J., Jin, X., Chen, C., Zhang, A., Wu, Y,, Chen, C. Hypermagnesaemia, but Not Hypomagnesaemia, Is a Predictor of Inpatient Mortality in Critically Ill Children with Sepsis. \u003cem\u003eDis Markers.\u003c/em\u003e \u003cstrong\u003e2022\u003c/strong\u003e:3893653. (2022); https://doi.org/10.1155/2022/3893653.\u003c/li\u003e\n\u003cli\u003eBroner, C.W., Stidham, G.L., Westenkirchner, D.F., Tolley, E.A. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients.\u003cem\u003e Crit Care Med\u003c/em\u003e\u003cstrong\u003e18\u003c/strong\u003e:921\u0026ndash;8. (1990) https://doi.org/10.1097/00003246-199009000-00004.\u003c/li\u003e\n\u003cli\u003ePollack, M.M., Holubkov, R., Glass, P., Dean, J.M., Meert, K.L., Zimmerman, J., et al. Functional Status Scale: New Pediatric Outcome Measure. \u003cem\u003ePediatrics\u003c/em\u003e\u003cstrong\u003e124\u003c/strong\u003e:e18\u0026ndash;28. (2009) https://doi.org/10.1542/peds.2008-1987.\u003c/li\u003e\n\u003cli\u003eRuttimann, U.E., Pollack, M.M., Patel, K.M. PRISM III: an updated Pediatric Risk of Mortality score. \u003cem\u003eCrit Care Med\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e:743\u0026ndash;752(1996). https://doi.org/10.1097/00003246-199605000-00004.\u003c/li\u003e\n\u003cli\u003eLeteurtre, S., Duhamel, A., Salleron, J., Grandbastien, B., Lacroix, J., Leclerc, F., et al. PELOD-2: an update of the Pediatric logistic organ dysfunction score. \u003cem\u003eCrit Care Med\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e:1761-1773. (2013) https://doi.org/10.1097/ccm.0b013e31828a2bbd.\u003c/li\u003e\n\u003cli\u003eGraciano, A.L., Balko, J.A., Rahn, D.S., Ahmad, N., Giroir, B.P. The Pediatric Multiple Organ Dysfunction Score (P-MODS); Development and validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children. \u003cem\u003eCrit Care Med\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e:1484\u0026ndash;1491(2005). https://doi.org/10.1097/01.ccm.0000170943.23633.47.\u003c/li\u003e\n\u003cli\u003eVerive, M.J., Irazuzta, J., Steinhart, C.M., Orlowski, J.P., Jaimovich ,D.G. Evaluating the frequency rate of hypomagnesemia in critically ill pediatric patients by using multiple regression analysis and a computer-based neural network. \u003cem\u003eCrit Care Med\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e:3534\u0026ndash;3539 (2000). https://doi.org/10.1097/00003246-200010000-00031.\u003c/li\u003e\n\u003cli\u003ePanahi, Y., Mojtahedzadeh, M., Najafi, A., Ghaini, M.R., Abdollahi, M., Sharifzadeh, M., et al. The role of magnesium sulfate in the intensive care unit. \u003cem\u003eEXCLI J\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e:464\u0026ndash;82 (2017). https://doi.org/10.17179/excli2017-182.\u003c/li\u003e\n\u003cli\u003eHansen, B-A., Bruserud, \u0026Oslash;. Hypomagnesemia in critically ill patients. \u003cem\u003eJ Intensive Care\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e:21(2018). https://doi.org/10.1186/s40560-018-0291-y.\u003c/li\u003e\n\u003cli\u003eSedlacek, M., Schoolwerth, A.C., Remillard, B.D. Electrolyte Disturbances in the Intensive Care Unit. \u003cem\u003eSemin Dial\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e:496\u0026ndash;501(2006). https://doi.org/10.1111/j.1525-139x.2006.00212.x.\u003c/li\u003e\n\u003cli\u003eFairley, J., Glassford, N.J., Zhang, L., Bellomo, R. Magnesium status and magnesium therapy in critically ill patients: A systematic review. \u003cem\u003eJ Crit Care\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e:1349\u0026ndash;1358. (2015) https://doi.org/10.1016/j.jcrc.2015.07.029.\u003c/li\u003e\n\u003cli\u003eEngland, M.R., Gordon, G., Salem, M., Chernow, B. Magnesium Administration and Dysrhythmias After Cardiac Surgery: A Placebo-Controlled, Double-blind, Randomized Trial. \u003cem\u003eJAMA\u003c/em\u003e;\u003cstrong\u003e268\u003c/strong\u003e:2395-2402(1992). https://doi.org/10.1001/jama.1992.03490170067027.\u003c/li\u003e\n\u003cli\u003ede Sevilla, M.\u0026Aacute;.C.F, \u0026Uacute;beda, M.G., Lugea, A.E., G\u0026oacute;mez, F.T. Magnesium in drugs: do we have enough information?. \u003cem\u003eFarm Hosp\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e:494\u0026ndash;495 (2014). https://doi.org/10.7399/fh.2014.38.6.8017.\u003c/li\u003e\n\u003cli\u003eAri, H.F., Turanli, E.E., Yavuz, S., Guvenc ,K., Avci, A., Keskin, A., Aslan, N., Yildizdas, D. Association between serum albumin levels at admission and clinical outcomes in pediatric intensive care units: a multi-center study. \u003cem\u003eBMC Pediatr\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e:844 (2024). https://doi.org/10.1186/s12887-024-05331-8\u003c/li\u003e\n\u003cli\u003eWang, Y., Wu, Q., Zhu, X., Wu, X., Zhu, P.. Lactate levels and the modified age-adjusted quick sequential organ failure assessment (qSOFA) score are fair predictors of mortality in critically ill pediatric patients. \u003cem\u003eAm J Emerg Med.\u003c/em\u003e \u003cstrong\u003e92\u003c/strong\u003e:85-90 (2025). https://doi.org/10.1016/j.ajem.2025.03.010. \u003c/li\u003e\n\u003cli\u003eArı, H. F., Keskin, A., Arı, M., Aci, R.. Importance of Lactate/Albumin Ratio in Pediatric Nosocomial Infection and Mortality at Different Times. \u003cem\u003eFuture Microbiology,\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e:51\u0026ndash;59. (2023) https://doi.org/10.2217/fmb-2023-0125\u003c/li\u003e\n\u003cli\u003eWang, B., Gong, Y., Ying, B., Cheng, B. Association of Initial Serum Total Calcium Concentration with Mortality in Critical Illness. \u003cem\u003eBiomed Res Int\u003c/em\u003e. \u003cstrong\u003e2018\u003c/strong\u003e:7648506. (2018) https://doi.org/10.1155/2018/7648506. \u003c/li\u003e\n\u003cli\u003eBarhight, M.F., Brinton, J., Stidham, T., Soranno, D.E., Faubel, S., Griffin, B.R., Goebel, J., Mourani, P.M., Gist, K.M. Increase in chloride from baseline is independently associated with mortality in critically ill children. \u003cem\u003eIntensive Care Med\u003c/em\u003e. \u003cstrong\u003e44\u003c/strong\u003e:2183-2191(2018). https://doi.org/10.1007/s00134-018-5424-1. \u003c/li\u003e\n\u003cli\u003eZhou,X., He, J., Zhu, D., Yao, Z., Peng, D., Zhang, X. Relationship between serum phosphate and mortality in critically ill children receiving continuous renal replacement therapy. \u003cem\u003eFront Pediatr.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e:1129156. (2023) https://doi.org/10.3389/fped.2023.1129156. \u003c/li\u003e\n\u003cli\u003eVeldscholte, K., Al Fify, M., Catchpole, A., Talwar, D., Wadsworth, J., Vanhorebeek, I., Casaer, M.P., Van den Berghe, G., Joosten, K.F.M., Gerasimidis, K., Verbruggen, S.C.A.T. Plasma and red blood cell concentrations of zinc, copper, selenium and magnesium in the first week of paediatric critical illness. \u003cem\u003eClin Nutr.\u003c/em\u003e\u003cstrong\u003e43\u003c/strong\u003e:543-551 (2024). https://doi.org/10.1016/j.clnu.2024.01.004. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Comparison between patients with hypomagnesemia and those who did not in relation to treatments, complications and mortality.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHypomagnesemia in the first analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 245px;\"\u003e\n \u003cp\u003eHypomagnesemia at some time during PICU stay\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eYes (N=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eNo (N=194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eYes (N=26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNo (N=174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;p\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eSex (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e33.3% (2/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e57.7% (112/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e53.8% (14/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e57.5% (100/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eAKI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e33.3% (2/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e10.3% (20/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e42.3% (11/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e6.3% (11/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eCRRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.1% (8/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e23.1% (6/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e1.7% (3/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eCardiac arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0% (0/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e2.1% (4/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e7.7% (2/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e1.1% (2/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eArrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e8.2% (16/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e11.5% (3/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e8% (14/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eShock\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e50.0% (3/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e3.6% (7/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e30.8% (8/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e1.1% (2/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eMechanical ventilation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e66.7% (4/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e46.4% (90/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e73.1% (19/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e43.1% (75/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eECMO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e3.1% (6/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e23.1% (6/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.6% (1/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eHeart surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e47.9% (93/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e38.5 % (10/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e48.3% (84/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eParalytic ileus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1% (2/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e7.7% (2/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.6% (1/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eMagnesium metamizole administration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e33.3% (2/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e55.2% (107/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e46.2% (12/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e55.7% (97/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eFurosemide (continuous infusion)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e83.3% (5/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e41.8% (81/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e65.4% (17/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e39.7% (69/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eVasoactive drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e50% (3/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e32% (62/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e50% (13/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e29.9% (52/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eMortality\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e16.7% (1/6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e3.1% (6/194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e15.4% (4/26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e1.7% (3/174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation.\u003c/p\u003e\n\u003cp\u003eCRRT: Continuous Renal Replacement Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Multivariate analysis of factors associated with magnesium disturbances at some time during admission.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"551\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Hypomagnesemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e95% C.I. OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAKI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCRRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCardiac arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eShock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMechanical ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFurosemide (continuous infusion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVasoactive drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 462px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eHypermagnesemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e95% C.I. OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCRRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHeart Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMagnesium metamizole\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFurosemide (continuous infusion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVasoactive drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation.\u003c/p\u003e\n\u003cp\u003eCRRT: Continuous Renal Replacement Therapy\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Hypermagnesemia in relation to treatment, complications and mortality.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypermagnesemia in the first analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypermagnesemia at some time during PICU stay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eYes (N=64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNo (N=136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eYes (N=89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eNo (N=111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e% (n/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eSex (male)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e56.3% (36/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e57.4% (78/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e57.3% (51/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e56.8% (63/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eAKI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e9.4% (6/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e11.8% (16/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e14.6% (13/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e8.1% (9/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eCRRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.7% (3/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e4.4 (6/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e7.8% (7/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.8% (2/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eCardiac Arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0% (0/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e2.9% (4/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.1% (1/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2.7% (3/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eArrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e4.7% (3/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e10.3% (14/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e9% (8/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e8.1% (9/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eShock\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0% (0/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e7.4% (10/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.4% (3/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6.3% (7/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eMechanical ventilation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e43.8% (28/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e48.5% (66/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e52.8% (47/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e42.3% (47/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eECMO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0% (0/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5.1% (7/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6.7% (6/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.9% (1/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eHeart surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e71.9% (46/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e35.3% (48/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e71.9% (64/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e27% (30/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eParalytic ileus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0% (0/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e2.2% (3/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2.2% (2/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.9% (1/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eAdministration of Magnesium metamizole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e68.8% (44/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e47.8% (65/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e66.3% (59/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e45% (50/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eFurosemide (continuous infusion)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e50% (32/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e39.7% (54/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e55.1% (49/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e33.3% (37/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eVasoactive drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e35.9% (23/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e30.9% (42/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e40.4% (36/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e26.1% (29/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eMortality\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0% (0/64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5.1% (7/136)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e4.5% (4/89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2.7% (3/111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAKI: Acute Kidney Injury. ECMO: Extracorporeal Membrane Oxygenation. CRRT: Continuous Renal Replacement Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of magnesium serum values at admission among patients undergoing heart surgery according to the cardioplegic solution used.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"665\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 119px;\"\u003e\n \u003cp\u003eNo cardioplegy\u003c/p\u003e\n \u003cp\u003e(n=10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCelsior\u003csup\u003eR\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(n=43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCustodiol\u003csup\u003eR\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(n=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePedro del Nido\u003csup\u003eR\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMagnesium (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 119px;\"\u003e\n \u003cp\u003e2.2 (2.3-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.9 (2.5-3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.1 (1.9-2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2.2 (2.1-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hypomagnesemia, hypermagnesemia, shock, mechanical ventilation, acute kidney injury, cardiac surgery","lastPublishedDoi":"10.21203/rs.3.rs-5940557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5940557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eTo analyse the prevalence of magnesium disturbances in children admitted to the Paediatric Intensive Care Unit (PICU) and its relationship with complications and mortality.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003esingle-center, observational, retrospective study. Children with measured serum magnesium levels were included. Clinical, analytical, treatment data, clinical severity scores (Functional Status Scale, Paediatric Risk of Mortality, Paediatric Logistic Organ Dysfunction and Paediatric Multiple Organ Dysfunction Score) at admission and during PICU admission, mortality and duration of admission were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003ea cohort of\u003cem\u003e \u003c/em\u003e200 children (57% male) with a median age of 55 months (interquartile range 8 months to 11 years) were included. Six children (3%) presented initial hypomagnesemia and 26 (13%) presented hypomagnesemia during admission. Hypomagnesemia during admission was significantly associated with the presence of acute kidney injury (AKI) (p=0.038), shock (p=0.003), and extracorporeal membrane oxygenation (ECMO) (p=0.046). Patients with hypomagnesemia had a higher mortality (15.4% versus 1.7%) (p=0.006). 64 children (32%) presented initial hypermagnesemia, and 89 (44.5%) presented hypermagnesemia during admission\u003cem\u003e.\u003c/em\u003e Hypermagnesemia during admission was significantly associated with heart surgery (p\u0026lt;0.001), without significant differences in mortality (p=0.702).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eHypomagnesemia and hypermagnesemia are common among children admitted to the PICU. Hypomagnesemia during admission was associated with AKI, shock, ECMO and mortality. Hypermagnesemia during admission was associated with cardiac surgery but not with mortality.\u003c/p\u003e","manuscriptTitle":"Magnesium disturbances in critically ill children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 09:44:35","doi":"10.21203/rs.3.rs-5940557/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-12T17:14:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-28T11:35:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184761833325726500920246342849736844435","date":"2025-04-26T02:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-25T18:26:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T08:54:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-24T18:37:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa9e2b01-fc62-4f58-822f-45a09bb256a4","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47785483,"name":"Health sciences/Diseases"},{"id":47785484,"name":"Health sciences/Medical research"},{"id":47785485,"name":"Health sciences/Nephrology"}],"tags":[],"updatedAt":"2025-05-26T16:07:09+00:00","versionOfRecord":{"articleIdentity":"rs-5940557","link":"https://doi.org/10.1038/s41598-025-02288-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-21 15:58:12","publishedOnDateReadable":"May 21st, 2025"},"versionCreatedAt":"2025-05-06 09:44:35","video":"","vorDoi":"10.1038/s41598-025-02288-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-02288-1","workflowStages":[]},"version":"v1","identity":"rs-5940557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5940557","identity":"rs-5940557","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}