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

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.