- Email: [email protected]
MON-P295: Association between Serum Micronutrient Levels in Patients Discharged from ICU to Wards and 90-Day Mortality, Re-Admission to Intensive Care Unit: Single Center Observational Study
Vitamins, antioxidants and minerals 2
Vitamins, antioxidants and minerals 2 MON-P294 MAGNESIUM SULPHATE ALLERGY AND SUBSEQUENT TOLERANCE TO MAGNESIUM CHLORIDE IN A PATIENT WITH INTESTINAL FAILURE K. C. Fragkos1 *, S. Mehta1, S. Di Caro1, F. Rahman1, M. Dziadzio2, J. Lukawska2,3. 1GI Services, 2Specialist Allergy and Clinical Immunology, University College London Hospitals Nhs Foundation Trust, 3Imaging Sciences, King’s College London, London, United Kingdom Rationale: Magnesium is commonly used in hospital medicine in treatment of eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Its utilisation is customary in patients with short bowel syndrome and intestinal failure, who often require intravenous magnesium sulphate (MgSO4). MgSO4 is also a routine additive in intravenous fluids for parenteral nutrition formulations. In spite of its frequent use, reports of allergic reactions to the compound are very rare (1). Methods: Case report Results: We present a case of a 40-year-ol female with a background of ileostomy and intestinal failure, who developed allergic reactions (skin flushing, skin rash, lip angioedema and throat tightness) to intravenous MGSO4 infusions, which precluded its further use. Patient was seen by in-house Clinical Allergy Service and skin testing to MgSO4 was performed. She tested negative to neat skin prick and positive at intradermal testing at 1:100 (non-irritant concentration). Suggesting possible IgE mediated mechanism. Skin testing was repeated with Magnesium Chloride (MgCl2). Patient tested negative to MgCl2 neat skin prick test and to intradermal testing at the same concentration. Subsequently, magnesium chloride infusion was performed and well tolerated with no evidence of allergic reaction. Conclusion: Magnesium is one of the most abundant minerals in human body and it is essential to our well-being. Allergic reactions to MGSO4 are very rare (only 3 cases described in the literature), however, when suspected pose a significant problem for patients and their clinicians. Following careful allergological review and skin testing, MgCl2 may represent a safe alternative in patients with allergy to MGSO4. Reference 1. Al-Fares AA, Abdulmalek KA, Al-Herz W. Magnesium sulfateinduced nonallergic anaphylaxis. Annals of Allergy, Asthma and Immunology 98: 303, No. 3, Mar 2007. Disclosure of Interest: None declared.
MON-P295 ASSOCIATION BETWEEN SERUM MICRONUTRIENT LEVELSIN PATIENTS DISCHARGED FROM ICU TO WARDS AND 90-DAY MORTALITY, RE-ADMISSION TO INTENSIVE CARE UNIT: SINGLE CENTER OBSERVATIONAL STUDY K. Gundogan1 *, Y. Gunay1, R. Coskun1, N. A. Mendil1, M. Guven1, M. Sungur1. 1Erciyes University, Kayseri, Turkey Rationale: Trace elements included in nutritional support have a central role in maintaining human physiological functions. The study aim of this study is to identify serum micronutrient levels in patients who are transferred from intensive care unit
S287 (ICU) to wards and their relationwith re-admission to ICU and mortality rate. Methods: This study was conducted prospectively in Erciyes University Medical ICU. Patients who are above 18 years old and stayed in the ICU more than 48 hours and then transferred to a ward were included into the study. Blood samples for micronutrient levels were taken at the time of transfer. Results: We enrolled 100 patients. Total of 52 of patients were male (52%) and 48 were female (48%). Mean agewas 56.2 ± 19.2 years. Mean APACHE II score was 15,4 ± 7,8. Mean SOFA score at the time of discharge from ICU was 3 (range 0–7). The route for nutrition was oral in 50%, enteral in 21%, oral and enteral in 13% and parenteral in 15% of the patients. Low levels of thiamine (98%), vitamin B6 (98%), vitamin B12 (11%), copper (21%), zinc (90%), selenium (36%), chromium (98%), and cobalt (35%)were identified in the patients. Low levels of vitamin B6 was an independent risk factor for 90 day mortality and re-admission to the ICUin multivariate analysis(OR: 0,283, CI 95%:0,099– 0,812, p: 0,019 OR: 0,231 CI 95%:0,071–0,745, p: 0,014 respectively). Median duration of ICU stay was 5 (range 3–32) days. Re-admission rate to the ICU within 90 days was 24% and 90 day mortality rate was 29%. Conclusion: Vitamin B1, B6, zinc and chromium levels were very low in these group patients. Low levels of vitamin B6 identified as an independent risk factor for 90 day mortality rate and re-admission to the ICU. Disclosure of Interest: None declared.
MON-P296 A SNAPSHOT OF VITAMIN D DEFICIENCY IN HOME PARENTERAL NUTRITION PATIENTS IN NORTHERN ENGLAND L. Shabeer1 *, D. Burke2. 1School of Medicine, University of Leeds, 2Department of Colorectal Surgery, St. James’s University Hospital, Leeds, United Kingdom Rationale: Vitamin D deficiency is increasingly common with an occurrence of 1 in every 5 adults, approximating to 10 million people across England in the general population. Those on home parenteral nutrition (HPN) are at increased risk of deficiency, making these patients of clinical interest. However, current data are limited to small sample size and the topic has not recently been explored in northern European countries. The aim of this study was to examine the prevalence of vitamin D deficiency in HPN patients in northern England. Methods: Serum Vitamin D (25-hydroxyvitamin D [(25(OH)D]) values from all HPN patients at St James’s Hospital, Leeds were obtained with sufficiency defined by the range, 75–250 nmol/ L. The most recent non-fasting serum values for vitamin D in the last six months, patient age and ethnicity were recorded. Results: Data were obtained on 139 patients (51 male and 88 female). 94% of patients were of White British ethnicity. Vitamin D levels in the sub-normal range were seen in 61.2%. Five patients did not have any recorded vitamin D values within the last six months. Similar levels of vitamin D insufficiency were seen between male and female cohorts (60.8% and 61.4% respectively). 28% of patients were over the age of 65 with 51.3% of these having insufficient vitamin D levels. Conclusion: This study uses the largest sample size to date and is the first study conducted in a European cohort. Inadequate vitamin D levels were seen amongst a large number of HPN patients, despite monitored supplementation. There is a need
Vitamins, antioxidants and minerals 2 MON-P294 MAGNESIUM SULPHATE ALLERGY AND SUBSEQUENT TOLERANCE TO MAGNESIUM CHLORIDE IN A PATIENT WITH INTESTINAL FAILURE K. C. Fragkos1 *, S. Mehta1, S. Di Caro1, F. Rahman1, M. Dziadzio2, J. Lukawska2,3. 1GI Services, 2Specialist Allergy and Clinical Immunology, University College London Hospitals Nhs Foundation Trust, 3Imaging Sciences, King’s College London, London, United Kingdom Rationale: Magnesium is commonly used in hospital medicine in treatment of eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Its utilisation is customary in patients with short bowel syndrome and intestinal failure, who often require intravenous magnesium sulphate (MgSO4). MgSO4 is also a routine additive in intravenous fluids for parenteral nutrition formulations. In spite of its frequent use, reports of allergic reactions to the compound are very rare (1). Methods: Case report Results: We present a case of a 40-year-ol female with a background of ileostomy and intestinal failure, who developed allergic reactions (skin flushing, skin rash, lip angioedema and throat tightness) to intravenous MGSO4 infusions, which precluded its further use. Patient was seen by in-house Clinical Allergy Service and skin testing to MgSO4 was performed. She tested negative to neat skin prick and positive at intradermal testing at 1:100 (non-irritant concentration). Suggesting possible IgE mediated mechanism. Skin testing was repeated with Magnesium Chloride (MgCl2). Patient tested negative to MgCl2 neat skin prick test and to intradermal testing at the same concentration. Subsequently, magnesium chloride infusion was performed and well tolerated with no evidence of allergic reaction. Conclusion: Magnesium is one of the most abundant minerals in human body and it is essential to our well-being. Allergic reactions to MGSO4 are very rare (only 3 cases described in the literature), however, when suspected pose a significant problem for patients and their clinicians. Following careful allergological review and skin testing, MgCl2 may represent a safe alternative in patients with allergy to MGSO4. Reference 1. Al-Fares AA, Abdulmalek KA, Al-Herz W. Magnesium sulfateinduced nonallergic anaphylaxis. Annals of Allergy, Asthma and Immunology 98: 303, No. 3, Mar 2007. Disclosure of Interest: None declared.
MON-P295 ASSOCIATION BETWEEN SERUM MICRONUTRIENT LEVELSIN PATIENTS DISCHARGED FROM ICU TO WARDS AND 90-DAY MORTALITY, RE-ADMISSION TO INTENSIVE CARE UNIT: SINGLE CENTER OBSERVATIONAL STUDY K. Gundogan1 *, Y. Gunay1, R. Coskun1, N. A. Mendil1, M. Guven1, M. Sungur1. 1Erciyes University, Kayseri, Turkey Rationale: Trace elements included in nutritional support have a central role in maintaining human physiological functions. The study aim of this study is to identify serum micronutrient levels in patients who are transferred from intensive care unit
S287 (ICU) to wards and their relationwith re-admission to ICU and mortality rate. Methods: This study was conducted prospectively in Erciyes University Medical ICU. Patients who are above 18 years old and stayed in the ICU more than 48 hours and then transferred to a ward were included into the study. Blood samples for micronutrient levels were taken at the time of transfer. Results: We enrolled 100 patients. Total of 52 of patients were male (52%) and 48 were female (48%). Mean agewas 56.2 ± 19.2 years. Mean APACHE II score was 15,4 ± 7,8. Mean SOFA score at the time of discharge from ICU was 3 (range 0–7). The route for nutrition was oral in 50%, enteral in 21%, oral and enteral in 13% and parenteral in 15% of the patients. Low levels of thiamine (98%), vitamin B6 (98%), vitamin B12 (11%), copper (21%), zinc (90%), selenium (36%), chromium (98%), and cobalt (35%)were identified in the patients. Low levels of vitamin B6 was an independent risk factor for 90 day mortality and re-admission to the ICUin multivariate analysis(OR: 0,283, CI 95%:0,099– 0,812, p: 0,019 OR: 0,231 CI 95%:0,071–0,745, p: 0,014 respectively). Median duration of ICU stay was 5 (range 3–32) days. Re-admission rate to the ICU within 90 days was 24% and 90 day mortality rate was 29%. Conclusion: Vitamin B1, B6, zinc and chromium levels were very low in these group patients. Low levels of vitamin B6 identified as an independent risk factor for 90 day mortality rate and re-admission to the ICU. Disclosure of Interest: None declared.
MON-P296 A SNAPSHOT OF VITAMIN D DEFICIENCY IN HOME PARENTERAL NUTRITION PATIENTS IN NORTHERN ENGLAND L. Shabeer1 *, D. Burke2. 1School of Medicine, University of Leeds, 2Department of Colorectal Surgery, St. James’s University Hospital, Leeds, United Kingdom Rationale: Vitamin D deficiency is increasingly common with an occurrence of 1 in every 5 adults, approximating to 10 million people across England in the general population. Those on home parenteral nutrition (HPN) are at increased risk of deficiency, making these patients of clinical interest. However, current data are limited to small sample size and the topic has not recently been explored in northern European countries. The aim of this study was to examine the prevalence of vitamin D deficiency in HPN patients in northern England. Methods: Serum Vitamin D (25-hydroxyvitamin D [(25(OH)D]) values from all HPN patients at St James’s Hospital, Leeds were obtained with sufficiency defined by the range, 75–250 nmol/ L. The most recent non-fasting serum values for vitamin D in the last six months, patient age and ethnicity were recorded. Results: Data were obtained on 139 patients (51 male and 88 female). 94% of patients were of White British ethnicity. Vitamin D levels in the sub-normal range were seen in 61.2%. Five patients did not have any recorded vitamin D values within the last six months. Similar levels of vitamin D insufficiency were seen between male and female cohorts (60.8% and 61.4% respectively). 28% of patients were over the age of 65 with 51.3% of these having insufficient vitamin D levels. Conclusion: This study uses the largest sample size to date and is the first study conducted in a European cohort. Inadequate vitamin D levels were seen amongst a large number of HPN patients, despite monitored supplementation. There is a need