Impact of magnesium on the clearance of lactate in critically sick patients with sepsis: Randomized clinical trial.

Abstract

Background: Sepsis is associated with impaired tissue perfusion and elevated serum lactate, a key prognostic marker. Magnesium plays a vital role in cellular energy metabolism and may enhance lactate clearance in sepsis.

Aim: To investigate the impact of magnesium on the clearance of lactate in critically sick patients with sepsis.

Methods: In this triple-blind, randomized trial, 138 adult patients with a diagnosis of sepsis (according to Sepsis-3 guidelines) and with serum lactate levels > 2 mmol/L were randomized into the magnesium (M) group and the placebo (P) group. Randomization was performed using an online sequence generator. The individuals in group M were administered 2 g of magnesium sulphate infusion diluted in 50 mL of normal saline over 2 hours for 3 days. The individuals in group P were administered an identical volume of normal saline for three days. The primary outcome was to compare the time to lactate clearance (20% decrease from baseline) in both groups. The secondary outcomes included changes in lactate clearance, intensive care unit (ICU) duration, hospital stay, and 28-day mortality in both groups.

Results: Time to 20% lactate clearance was considerably lower in the M group (5.73 ± 2.19 hours) when compared to the P group (8.54 ± 2.72 hours), with a mean difference [95% confidence interval (CI)]: -2.81 (-3.65 to -1.99), P < 0.001. Mean rise in lactate clearance was markedly more significant in M group than P group on day 1 [18.88% ± 1.80% vs 12.61% ± 1.94% respectively, with mean difference (95%CI): 6.26 (5.63-6.89), P < 0.001] on day 2 [30.02% ± 4.30 % vs 23.34% ± 4.76% respectively, with mean difference (95%CI): 6.68 (5.15-8.20), P < 0.001] and day 3 [50.74% ± 6.06 % vs 37.94% ± 4.53% respectively, with mean difference (95%CI): 12.80 (11.00-14.60), P < 0.001]. The length of ICU stay was considerably shorter in the M group, 8 (3-15) days, compared to the P group, 12 (5-19) days (P < 0.001). The duration of hospitalization was significantly decreased in the M group, 12 (4-24) days than in the P group, 16 (9-25) days (P < 0.001); however, the 28-day mortality was similar in both groups.

Conclusion: Magnesium supplementation was associated with shorter lactate clearance time and reduced ICU and hospital stay duration in patients with sepsis; however, the difference in 28-day mortality between the groups was statistically nonsignificant.