Category: Professional Posters
Purpose: The indications, measurement of levels and treatment of hypomagnesemia with IV MgSO4 are not well defined among hospitalized patients. In 2011, IV MgSO4 has been reported as one of the medications being in short supply worldwide. In Lebanon, there is no available literature that examined the trend of IV MgSO4 consumption in hospital wards till this date. Therefore, the purpose of this study is to examine the trend of IV MgSO4 consumption in a Lebanese hospital over the last 5 years. In addition, this study will also explore the drug utilization review of IV MgSO4 in different hospital wards.
Methods: The Institutional Review Board of the hospital and research committee of the Lebanese International University-School of Pharmacy approved this retrospective cross-sectional study that was conducted from February 2019 till May 2019. Medical charts for patients who received IV MgSO4 were reviewed from 2014 till 2018 stratified by hospital wards were enrolled in this study. To assess the study primary outcome the daily consumption of IV MgSO4 was quantified to estimate the total grams of IV MgSO4 used in each year. As for the secondary outcomes, dichotomous data was presented as percentages and continuous data was presented as means. Pearson Chi square test and Fisher exact test was used to estimate the odds ratios and to estimate bivariate associations. T test was used to analyze continuous data. Binary logistic regression was use to estimate strength and precession of the associations taking into consideration age, gender, correct dose, monitoring and therapeutic appropriateness of IV MgSO4, corrected magnesium (Mg), calcium (Ca), serum creatinine (SrCr), and potassium (K) levels after IV MgSO4 administration.
Results: Among the 331 hospitalized patients IV MgSO4 use has increased by 1.05 fold from 2014 to 2018. From 2016 till 2018, the incorrect therapeutic appropriateness IV MgSO4 was 48.8% (p=0.01). Bivariate analysis showed that there was no direct association between the corrected level of Mg after IV MgSO4 and death. However, the percentage (%) of death among patients who had corrected Ca level (5.2 %) after IV MgSO4 was lower compared to those with no corrected Ca level (16.0%) (P value=0.05). As for the for the % of death among patients who had corrected SrCr (5.5 %) after IV MgSO4 was lower compared to those with no corrected SrCr level (22.5 %) (P value < 0.01). Binary logistic regression showed that with every increase in age by one year, risk of death increased by 1.055 (P value < 0.01). In addition, abnormal SrCr level after IV MgSO4 increase the risk of death in patients by 1.02 (P value < 0.01) compared to those with normal SrCr level.
Conclusion: According to study findings, the IV MgSO4 consumption in hospital had increased over the last 5 years which cannot be explained for by medical indications. It is worth mentioning that there was a significant difference in therapeutic appropriateness between years due to the absence of guided protocol of IV MgSO4 use in hospital wards. The risks and benefits of IV MgSO4 deserve further investigations as IV MgSO4 administration significantly affect other electrolytes. Based on this study, special precautions should be undertaken in elderly patients when it comes in correcting Mg level, Ca and Scr.