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Abstract
Le magnésium est un ion régulateur des canaux K+, Na+ et Ca++ au niveau de la cellule myocardique, et son activité anti-arythmique est bien connue, notamment dans le traitement des troubles du rythme supra ventriculaires, ventriculaires et les torsades de pointes. Le déficit en magnésium se manifeste par des désordres électrolytiques, des signes neuromusculaires et cardiovasculaires pouvant engager le pronostic vital. Le traitement repose sur la supplémentation intraveineuse et per os. En périopératoire de chirurgie cardiaque, la survenue de l’hypomagnésémie est multifactorielle et sa responsabilité dans la genèse des complications postopératoires doit être prise en compte. Dans l’objectif de rappeler l’importance du magnésium chez ces patients, nous rapportons un cas de torsades de pointe par hypomagnésémie survenue en postopératoire d’un triple pontage aorto-coronarien chez un patient diabétique de 63 ans.
ABSTRACT
Magnesium is one of the important ion the regulation of K+, Na+ et Ca++ channels interfering with the myocardial cell, and its anti-arrhythmic activity is well documented as well in the treatment of ventricular and supra-venticular rhythm disorders and torsades de pointe. The clinical manifestations of magnesium deficiency are electrolytic disorders, neuromuscular and cardiovascular symptoms which may be life threatening. The treatment Intravenous and oral supplementation is the treatment.
In perioperative course of cardiac surgery, the occurrence of hypomagnesemia is multifactorial and its responsibility in postoperative outcomes may be taken in account. Authors aimed to remember the relevance of blood magnesium level in these patients, and report a case of torsades de pointe occurred after a coronary by-pass graft in a 36 years old patient.
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References
- Gitelman HJ, Graham JB, Welt LG. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physicians. 1966;79:221-35.
- Scognamiglio R, Semplicini A, Calò L. Myocardial function in Bartter’s and Gitelman’s syndromes. Kidney Int 2003;64:366–7.
- Ren H, Qin L, Wang W, Ma J, Zhang W et al. Abnormal glucose metabolism and insulin sensitivity in Chinese patients with Gitelman syndrome. Am J Nephrol. 2013; 37(2):152-7.
- Pearson JP, Evora PRB, Seccombe JF, Schaff HV. Hypomagnesemia Inhibits Nitric Oxide Release From Coronary Endothelium: Protective Role of Magnesium Infusion After Cardiac Operations. Ann Thorac Surg. 1998; 65:967–72.
- Luk CP, Parsons R, Lee YP, Hughes JD. Proton Pump Inhibitor–Associated Hypomagnesemia: What Do FDA Data Tell Us? Ann Pharmacother. 2013; 47:773-80.
- Badran AM, Joly F, Messing B. L’hypomagnésémie: causes, manifestations et traitement. Nutrition clinique et metabolisme. 2004; 18(3):127-130.
- Marsepoil T, Blin F, Hardy F, Letessier G, Sebbah JL. Torsades de pointe et hypomagnésémie. Ann. Fr. Anesth. Reanim. 1985; 4: 524-526.
- Cohen JD, Blumenthal R, Horn HR, Weintraub H, Weglicki W. Torsades de pointes, a potential complication of diuretic-induced hypokalemia and hypomagnesemia in patients with congestive heart failure: Conference presentation of a generic patient. Curt Ther Res Clin Exp. 2002;63:803-809.
- Karaki H. Magnesium as a modifier of smooth muscle contractility; Microcirc Endothelium Lymphatics. 1989; 5: 77–97.
- Bibawy JN, Parikh V, Wahba J, Barsoum EA, Lafferty J et al. Pantoprazole (Proton Pump Inhibitor) Contributing to Torsades de Pointes Storm; Circ Arrhythm Electrophysiol. 2013; 6: 17-20.
- Al –Ghamdi SM, Cameron EC, Sutton SA. Magnesium deficiency: pathophysiology and clinical overview. Am J Kidney Disease. 1994; 24:737–52.
- Pachulski RT, Lopez F, Sharaf R. Gitelman's Not-So-Benign Syndrome. N Engl J Med. 2005; 353:850-851.
- Scognamiglio R, Calò LA, Negut C, Coccato M, Mormino P, Pessina AC. Myocardial perfusion defects in Bartter and Gitelman syndromes. Eur J Clin Invest. 2008; 38(12):888-95.
- Benmoussa S, Kherroubi M; Anomalie du métabolisme glucidique et syndrome de Gitelman : à propos d’un cas. Annales d'Endocrinologie. 2015; 76 (4): 520.
- Pasquier M, Pantet O, Hugli O, Pruvot E, Buclin T, Waeber G, Aujesky D. Prevalence and determinants of QT interval prolongation in medical inpatients. Intern Med J. 2012; 42(8):933-40.
References
Gitelman HJ, Graham JB, Welt LG. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physicians. 1966;79:221-35.
Scognamiglio R, Semplicini A, Calò L. Myocardial function in Bartter’s and Gitelman’s syndromes. Kidney Int 2003;64:366–7.
Ren H, Qin L, Wang W, Ma J, Zhang W et al. Abnormal glucose metabolism and insulin sensitivity in Chinese patients with Gitelman syndrome. Am J Nephrol. 2013; 37(2):152-7.
Pearson JP, Evora PRB, Seccombe JF, Schaff HV. Hypomagnesemia Inhibits Nitric Oxide Release From Coronary Endothelium: Protective Role of Magnesium Infusion After Cardiac Operations. Ann Thorac Surg. 1998; 65:967–72.
Luk CP, Parsons R, Lee YP, Hughes JD. Proton Pump Inhibitor–Associated Hypomagnesemia: What Do FDA Data Tell Us? Ann Pharmacother. 2013; 47:773-80.
Badran AM, Joly F, Messing B. L’hypomagnésémie: causes, manifestations et traitement. Nutrition clinique et metabolisme. 2004; 18(3):127-130.
Marsepoil T, Blin F, Hardy F, Letessier G, Sebbah JL. Torsades de pointe et hypomagnésémie. Ann. Fr. Anesth. Reanim. 1985; 4: 524-526.
Cohen JD, Blumenthal R, Horn HR, Weintraub H, Weglicki W. Torsades de pointes, a potential complication of diuretic-induced hypokalemia and hypomagnesemia in patients with congestive heart failure: Conference presentation of a generic patient. Curt Ther Res Clin Exp. 2002;63:803-809.
Karaki H. Magnesium as a modifier of smooth muscle contractility; Microcirc Endothelium Lymphatics. 1989; 5: 77–97.
Bibawy JN, Parikh V, Wahba J, Barsoum EA, Lafferty J et al. Pantoprazole (Proton Pump Inhibitor) Contributing to Torsades de Pointes Storm; Circ Arrhythm Electrophysiol. 2013; 6: 17-20.
Al –Ghamdi SM, Cameron EC, Sutton SA. Magnesium deficiency: pathophysiology and clinical overview. Am J Kidney Disease. 1994; 24:737–52.
Pachulski RT, Lopez F, Sharaf R. Gitelman's Not-So-Benign Syndrome. N Engl J Med. 2005; 353:850-851.
Scognamiglio R, Calò LA, Negut C, Coccato M, Mormino P, Pessina AC. Myocardial perfusion defects in Bartter and Gitelman syndromes. Eur J Clin Invest. 2008; 38(12):888-95.
Benmoussa S, Kherroubi M; Anomalie du métabolisme glucidique et syndrome de Gitelman : à propos d’un cas. Annales d'Endocrinologie. 2015; 76 (4): 520.
Pasquier M, Pantet O, Hugli O, Pruvot E, Buclin T, Waeber G, Aujesky D. Prevalence and determinants of QT interval prolongation in medical inpatients. Intern Med J. 2012; 42(8):933-40.