The role of magnesium in the treatment of alcohol withdrawal with delirium

Authors

  • O.O. Havrylov National Pirogov Memorial Medical University, Vinnytsia, Ukraine, Ukraine
  • M.L. Gomon National Pirogov Memorial Medical University, Vinnytsia, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.8.2021.245573

Keywords:

magnesium, sedation, alcohol withdrawal, delirium

Abstract

Background. The role of magnesium in the treatment of alcohol withdrawal with delirium is indefinite, although it is well known about its participation in the pathogenesis of this severe condition. The study was aimed to reveal the benefits and disadvantages of the sedation with added magnesium sulfate in comparison with traditional sedative therapy. Materials and methods. In our study, we tested 40 treated patients, which were randomized in two groups. We controlled the level of sedation by the Richmond agitation-sedation scale. The target level of sedation was between 0 and –2 points. We maintained this level in all the patients. In all groups, we evaluated the following values: duration of delirium, mean arterial pressure, pulse, the level of serum magnesium, cortisol and serotonin, laboratory indicators of kidneys, and liver condition. In the control group, we carried out the sedation with 10–
20 mg of diazepam every 4–6 hours with infusion of barbiturates as needed. The treatment in the research group was identical with addition of magnesium sulfate 50 mg/kg every 8 hours. Results. The results of the study demonstrated that the duration of delirium is significantly lower in the research group in comparison with the control (p < 0.05). We found hypomagnesemia in almost half of the patients. The indicators of haemodynamics such as mean arterial pressure and pulse were significantly lower in both groups on the third day (p < 0.05). We found 4 cases (20 %) of hypotension in the research group and 2 cases (10 %) in the control group. The study of the dynamics of serum cortisol and serotonin showed the significant difference on the third day in both groups (p < 0.05). We found no difference in these laboratory parameters on the third day between groups (p ≥ 0.05). There was no significant difference between the laboratory indicators of kidneys and liver condition in both groups (p ≥ 0.05). Conclusions. The use of magnesium sulfate allowed decreasing the duration of delirium but had an excessive effect on haemodynamics. Such biomarkers as serum cortisol and serotonin didn’t verify the effect of magnesium sulfate.

References

Langlois H, Cormier M, Villeneuve E, Hoffman RS, Longo C, Gosselin S. Benzodiazepine resistant alcohol withdrawal: What is the clinician's preferred definition? CJEM. 2020 Mar;22(2):165-169. doi: 10.1017/cem.2019.421. PMID: 31645232.

Calixto E. GABA withdrawal syndrome: GABAA receptor, synapse, neurobiological implications and analogies with other abstinences. Neuroscience. 2016 Jan 28;313:57-72. doi: 10.1016/j.neuroscience.2015.11.021. Epub 2015 Nov 18. PMID: 26592722.

Hansen AW, Almeida FB, Bandiera S, Pulcinelli RR, Caletti G, Agnes G, Fernandes de Paula L, Nietiedt NA, Nin MS, Tannhauser Barros HM, Gomez R. Correlations between subunits of GABAA and NMDA receptors after chronic alcohol treatment or withdrawal, and the effect of taurine in the hippocampus of rats. Alcohol. 2020 Feb;82:63-70. doi: 10.1016/j.alcohol.2019.08.005. Epub 2019 Aug 29. PMID: 31473305.

Hou H, Wang L, Fu T, Papasergi M, Yule DI, Xia H. Magnesium Acts as a Second Messenger in the Regulation of NMDA Receptor-Mediated CREB Signaling in Neurons. Mol Neurobiol. 2020 Jun;57(6):2539-2550. doi: 10.1007/s12035-020-01871-z. Epub 2020 Mar 25. PMID: 32215817; PMCID: PMC8202957.

Sarai M, Tejani AM, Chan AH, Kuo IF, Li J. Magnesium for alcohol withdrawal. Cochrane Database Syst Rev. 2013 Jun 5;(6):CD008358. doi:10.1002/14651858.CD008358.pub2. PMID: 23740536.

Maguire D, Ross DP, Talwar D, Forrest E, Naz Abbasi H, Leach JP, Woods M, Zhu LY, Dickson S, Kwok T, Waterson I, Benson G, Scally B, Young D, McMillan DC. Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. Eur J Clin Invest. 2019 Sep;49(9):e13152. doi: 10.1111/eci.13152. Epub 2019 Jul 1. PMID: 31216056.

Yoldas H, Yildiz I, Karagoz I, Sit M, Ogun MN, Demirhan A, Bilgi M. Effects of Bispectral Index-controlled Use of Magnesium on Propofol Consumption and Sedation Level in Patients Undergoing Colonoscopy. Medeni Med J.2019;34(4):380-386. doi: 10.5222/MMJ.2019.99705. Epub 2019 Dec 26. PMID: 32821465; PMCID: PMC7433725.

Diringer M. Neurologic manifestations of major electrolyte abnormalities. Handb Clin Neurol. 2017;141:705-713. doi: 10.1016/B978-0-444-63599-0.00038-7. PMID: 28190443.

Ishida Y, Tabuchi A. Severe Hypermagnesemia with Normal Renal Function Can Improve with Symptomatic Treatment. Case Rep Emerg Med. 2020 Jul 14;2020:2918249. doi: 10.1155/2020/2918249. PMID: 32733713; PMCID: PMC7376418.

Kurajoh M, Ohsugi K, Kakutani-Hatayama M, Shoji T, Koyama H. Hypokalemia associated with pseudo-Cushing's syndrome and magnesium deficiency induced by chronic alcohol abuse. CEN Case Rep. 2018 May;7(1):148-152. doi: 10.1007/s13730-018-0315-4. Epub 2018 Feb 15. PMID: 29450857; PMCID: PMC5886946.

Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients. 2018 Jun 6;10(6):730. doi: 10.3390/nu10060730. PMID: 29882776; PMCID: PMC6024559.

Vink R. Magnesium in the CNS: recent advances and developments. Magnes Res. 2016 Mar 1;29(3):95-101. doi: 10.1684/mrh.2016.0408. PMID: 27829572.

Van Laecke S. Hypomagnesemia and hypermagnesemia. Acta Clin Belg. 2019 Feb;74(1):41-47. doi: 10.1080/17843286.2018.1516173. Epub 2018 Sep 17. PMID: 30220246.

Ismail AAA, Ismail Y, Ismail AA. Chronic magnesium deficiency and human disease; time for reappraisal? QJM. 2018 Nov 1;111(11):759-763. doi: 10.1093/qjmed/hcx186. PMID: 29036357.

Dyal S, MacLaren R. The Assessment and Management Practices of Acute Alcohol Withdrawal: Results of a Nationwide Survey of Critical Care Pharmacists. Hosp Pharm. 2019 Feb;54(1):22-31. doi: 10.1177/0018578718769241. Epub 2018 Apr 13. PMID: 30718931; PMCID: PMC6333955.

Vinogradov DB, Sinitskiy AI. Laboratornye prediktory tiazhesti alkogol'nogo deliriia [Laboratory predictors of delirium tremens severity]. Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(4 Pt 2):9-13. Russian. doi: 10.17116/jnevro2015115429-13. PMID: 26288296.

Jochum T, Hoyme J, Schulz S, Weißenfels M, Voss A, Bär KJ. Diverse autonomic regulation of pupillary function and the cardiovascular system during alcohol withdrawal. Drug Alcohol Depend. 2016 Feb 1;159:142-51. doi: 10.1016/j.drugalcdep.2015.12.030. Epub 2016 Jan 4. PMID: 26790823.

Published

2021-12-07

Issue

Section

Original Researches