G. A Kurian1, J. Paddikkala2
1Assistant Professor Medical Biochemistry, School of Chemical and Biotechnology, SASTRA University, Tamil Nadu, India; 2Department of Plant Biotechnology, Amala Cancer Research Center, Amalanagar, Trichur, Kerala
[Applied Cardiopulmonary Pathophysiology 14: 29-39, 2010]
Introduction: Some of the previous studies reported distant organ injury like liver injury and renal failure after cardiac surgery, whereas in other studies no injury was identified. Magnesium (Mg) deficiency commonly occurs in critical illness and correlates with a higher mortality and worse clinical outcome in the intensive care unit (ICU). Accordingly, this study was designed to assess the effect of magnesium on liver and kidney function abnormalities during CABG procedure in an Indian population.
Methods: A clinical trial (n= 52) was conducted to determine the effects of magnesium (16mEq) on distant organs, administered just before the release of aortic cross clamp in patients undergoing coronary bypass operations. We took five blood samples at different times during cardiac surgery and analyzed the levels of ALT, AST, ALP, uric acid, total protein and creatinine. Cardiac marker enzymes like CPK MB, Troponin I and LDH were analyzed. Moreover, the antioxidant enzymes in erythrocytes like catalase, glutathione peroxidase, superoxide dismutase and glutathione reductase activity were determined along with the level of TBARS.
Results: Patients undergoing surgical myocardial revascularization revealed a decrease of antioxidant enzyme activities of erythrocytes in patients with and without magnesium administration during ischemic reperfusion. The product of lipid peroxidation (thiobarbituric acid reactive substances) in erythrocytes increased but the extent of release was more in patients treated without magnesium. Similarly, a significant improvement in the cardiac marker enzymes was observed in Mg treated patients. The altered biochemical changes in liver and kidney associated with ischemic reperfusion suggested the impact of revascularization injury and improved significantly in Mg treated patients.
Conclusion: These results reveal an increase in oxidative stress after CPB in erythrocytes; thereby it can adversely affect distant organs like liver and kidney. The extensive treatment of patients with magnesium influences the cellular response to ischemia and thus induces protection to heart and other organs.
Key words: anti oxidant, liver function, kidney function, myocardial ischemia, reperfusion, magnesium
Address for corresponding:
Gino A Kurian, Assistant Professor Medical Biochemistry, School of Chemical and Biotechnology, SASTRA University, Thirumalaisamudram,Thanjavur, Tamil Nadu, India