In this work we analyze plasma ionic levels in patients with septic shock before and after treatment with different antioxidants. After a treatment with 4 types of antioxidants (n-acetyl cysteine, melatonin, vitamin C and vitamin E, we found a change in ionic levels, mainly in ionized magnesium.
Different studies have tried to establish the electrolyte alterations associated with septic shock, particularly in the length of stay in an ICU, however, the studies are still very scarce.
There are reports where Mg2+ deficiency, together with other electrolyte abnormalities, coexists in up to 40% of patients . Various factors can contribute to hypomagnesemia in patients with septic shock, such as: decreased absorption caused by impaired gastrointestinal activity, malnutrition, diabetes mellitus, hypokalemia and hypocalcemia , hyperaldosteronism, renal tubular disorder, use of drugs such as amphotericin, cisplatin, cyclosporine, diuretics, proton pump inhibitors, and aminoglycoside antibiotics of which some are used during the management of septic shock and others may be being applied prior to septic shock due to cancer or other conditions.
Thus, several reports indicate that hypomagnesemia is associated with a higher mortality rate [13, 15, 16]. In our study, we found low levels of magnesium compared to control subjects in both groups of patients with sepsis; After treatment with different antioxidants, there was an increase in the serum levels of ionized magnesium, however, these values did not reach the levels of the control subjects. The presence of hypomagnesemia can lead to neurological disorders such as diffuse muscle spasms, lethargy, ataxia, nystagmus, twitching, tetany, or seizures. At the muscular level, there may be weakness of the respiratory muscles, hypoventilation, dysphagia and dysphonia; while at the cardiovascular level there may be a prolongation of the P-R and Q-T segments, atrial and ventricular arrhythmias, as well as congestive heart failure. On the other hand, we also observed alterations in the levels of other serum electrolytes such as sodium, potassium and calcium. There are reports that indicate that the decrease in magnesium levels may be accompanied by a reduction in the levels of K+ (hypokalemia) and Ca2+ (hypocalcemia) [17, 18]. This is because part of calcium metabolism is controlled by the activity of parathyroid hormone (PTH), which seems to be the site of action of magnesium for modulation of calcium balance, since serum magnesium deficiency inhibits the action of PTH in bone, directly preventing calcium release [19, 20]; furthermore, PTH secretion is prevented, since magnesium is a cofactor of the adenylate cyclase enzyme in parathyroid tissue. It has been observed that when hypokalemia occurs, there is the presence of hypomagnesemia in 40%; Likewise, when hypocalcemia is present, hypomagnesemia is present in 22%. [17, 20, 21]. On the other hand, when there is a decrease in potassium levels (hypokalemia), it is known that Mg2+ participates in the flow of Na+ and K+ in the cell membrane, since it acts as a cofactor in the Na-K ATPase, generating an electrochemical gradient and therefore an alteration in the membrane potential that can cause changes in excitability and / or irritability at the neuromuscular level.
Our results show a clear decrease in the serum levels of Na+, K+ and Ca2+ with respect to the control subjects. In the different treatments with antioxidants, we found an increase in the levels of these electrolytes despite not finding a statistically significant increase. These differences were independent of the type of treatment given. This may be due to different reasons, including the number of patients with septic shock, the time between the initial and final sampling, and therefore the time of treatment with antioxidants. However, despite the foregoing, a physiologically important change was observed in the serum levels of the studied ions. Therefore, it is important to correct magnesium levels, to maintain adequate levels mainly of calcium and potassium in patients with septic shock.
Finally, when carrying out the analysis of the electrolytes studied before and after the treatment with antioxidants, according to the SOFA score, an important change was observed mainly in the subjects with severe scores in Na+ and Mg2+ levels. This indicates that, the greater the severity of the damage, the antioxidant therapy, regardless of what it is, causes an improvement in the patient, mainly in the levels of magnesium, which, as mentioned above, is an ion that participates in the regulation of other electrolytes and that can help improve the patient's condition.
This study leads to propose that in patients admitted with septic shock, medical management should consider, in addition to standard therapy, antioxidant therapy and specific electrolyte monitoring. The importance of determining magnesium in the basal state allows defining the deficit, which leads to septic shock. The determination of ionized magnesium could be a useful biomarker to include during the study and follow-up of patients in extreme severity