Endocrine Abstracts

The role of magnesium in electrolyte homeostasis is well established. ATP/ADP structure, refractory hypokalemia and calcium homeostasis are some of the established roles in literature, well known to Endocrine. However, currently no NICE guidelines exist for low magnesium. Our first audit in 2018 focused on patient admissions during January 2018. We found 49 patients with Mg < 0.5. Majority were care of the Geriatrics, 8 under Gastroenterology, 4 under Endocrinology. 31 patients were found to be on proton pump inhibitors (PPI’s). However we found that only 8 patients had their PPI’s discontinued on discharge and only 8 patients had hypomagnesemia on noted on their discharge letter. Most common causes listed on requests by acute/general medical wards included diabetics, on drugs (PPI), alcohol excess, diarrhoea. Second audit in 2021 was spread over a collection period of 01/11/20 - 01/02/21. A total of 5424 patients were analyzed. We found Mg < 0.4 in 37 patients, Mg 0.4-0.5 in 95 patients, Mg 0.5- 0.7 in 1469 patients and Mg < 0.7 in 1601 patients. A majority of investigations were from endocrine/gastro/hematology wards (>70%) with acute medicine having only 12% of these requests despite maximum admissions. Incidence of Mg requested for concurrent potassium level less than 3.0 was 67%. 41/132 of patients with potassium less than 3.5 were found to have a magnesium less than 0.5. PPI’s were discontinued in patients with Mg less than 0.5 in only 20 out of 87 patients. Hypomagnesemia was mentioned on discharge summary (when Mg less than 0.5) for only 65 out of 120 patients. Both studies done over a gap of 4 years revealed significant gaps in knowledge of hypomagnesemia. We agree that we need to establish strong local, regional and national guidelines for hypomagnesemia.

*All units in mmols/l.