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Hypomagnesemia Is a Frequent Finding in the Emergency Department in Patients With Chest Pain
Michael Salem, MD;
Nelson Kasinski, MD;
Anna Marie Andrei, MD;
Thomas Brussel, MD;
Michael R. Gold, MD, PhD;
Alasdair Conn, MD;
Bart Chernow, MD
Arch Intern Med. 1991;151(11):2185-2190.
Abstract
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Study Objective.—
To evaluate the frequency of low blood levels of total and ultrafilterable magnesium (total and ultrafilterable hypomagnesemia) in patients with chest pain in the emergency department, and to determine if hypomagnesemia is associated with other clinically important diagnostic and outcome variables in cardiac care.
Setting.—
An emergency department of a university teaching hospital.
Design. —
Prospective study of extracellular magnesium homeostasis in patients with chest pain in the emergency department and a cohort of patients without chest pain with a clinical indication for blood sampling.
Patients. —
During a 4-month period, 147 patients presenting to the emergency department were studied: 67 patients (mean±SD age, 61.4±13 years) with a chief complaint of chest pain (study group) and 80 patients (55.6±19 years) with other diagnoses (control group).
Results.—
Total and ultrafilterable hypomagnesemia occurred more frequently in patients with chest pain (20/67 [30%] and 9/67 [13%]) than in the control group (12/80 [15%] and 3/80 [4%]). Patients with a chief complaint of chest pain who were receiving diuretic medications were hypomagnesemic more frequently (9/16 [56%]) than patients not receiving diuretics (12/51 [23%]). In patients with chest pain admitted to the hospital with a diagnosis of "rule out" myocardial infarction, the frequency of hypokalemia was greater among hypomagnesemic patients (6/14 [43%]) than normomagnesemic patients (3/31 [10%]). A similar frequency of hypomagnesemia was noted in patients with a final diagnosis of myocardial infarction (4/15 [27%]) when compared with other patients admitted with chest pain (10/31 [32%]) in whom myocardial infarction was excluded. No association was noted among hypomagnesemia and length of hospital stay or the occurrence of hypotension or dysrhythmias.
Conclusions.—
Total and ultrafilterable hypomagnesemia are frequent occurrences in patients with and without chest pain in the emergency department. Diuretic use is associated with hypomagnesemia in patients presenting with chest pain in the emergency department. These results support the concept that hypomagnesemia is common in patients with chest pain in the emergency department and is associated with hypokalemia but is not predictive of whether the patient with chest pain has had an acute myocardial infarction.
(Arch Intern Med. 1991;151:2185-2190)
Author Affiliations
From the Department of Medicine, Sinai Hospital of Baltimore (Md), and the Departments of Medicine, Anesthesiology, and Critical Care Medicine (Drs Salem and Chernow), The Johns Hopkins University School of Medicine, Baltimore; and the Departments of Emergency Services (Dr Conn) and Anesthesiology (Critical Care) (Drs Salem, Kasinski, Andrei, Brussel, and Chernow), and the Cardiac Unit (Dr Gold), Massachusetts General Hospital, Harvard Medical School, Boston. Drs Salem and Chernow are now with the Sinai Hospital of Baltimore and The Johns Hopkins University School of Medicine.
Footnotes
Accepted for publication May 31, 1991.
Reprint requests to Sinai Hospital of Baltimore, Belvedere Avenue at Greenspring, Baltimore, MD 21215 (Dr Chernow).
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