Poster (15W113)

Home subcutaneous fluids for Magnesium stabilisation - a review of patients in the Belfast trust

Author(s)

Adgey Carolyn, McKenna Catriona, Murray Emma, Turner Graham, Rafferty Gerard.

Department(s)/Institutions

Intestinal Failure Service, Belfast Trust

Introduction

All patients who require home subcutaneous fluids (SCF) for gastrointestinal disease in Northern Ireland are managed through the intestinal failure unit in the Belfast trust. There is a wide range of indications for usage and patients felt to be good candidates are referred to the unit for assessment and training by a multidisciplinary nutrition team. The majority of patients required SCF for stabilisation of magnesium. There are two studies in the literature regarding effectiveness and safety of home sub cut fluids 1,2.

Aims/Background

To assess safety and effectiveness of magnesium stabilisation using SCF in the Belfast trust

Method

Data was collected using the electronic care record. Demographic data, underlying diagnosis and anatomy was collected for all patients. Magnesium levels were reviewed before SCF were initiated and compared with levels at one month to establish if SCF did in fact normalise magnesium and maintain this resolution

Results

There were 35 patients who have used SCF for any period of time over the last 9 years. 30 of these patients had magnesium replacement in their SCF. 16 of these were female (53%). Age at initiation ranged from 45-76 with a median of 56.5 years.

Each patient received 4 mmol of Magnesium in a bag. The volume of fluid in the bag varied from patient to patient. Crohns disease, ischaemia and post operation complications made up the majority of patients requiring SCF with magensium (87%).

Review of blood tests revealed:

Pre SCF median (interquartile range)
Magnesium 0.57 (0.515-0.615)

1 month median (interquartile range)
Magnesium 0.78 (0.725-0.855)

P value
Magnesium <0.001

Two patients had admissions after SCF initiation with cellulitis at needle site. Four other patients required admission following initiation of SCF for dehydration. Three of these were resolved with medication to reduce stoma output. However one patient required HPN.

Conclusions

Home SCF with magnesium can be safely used to stabilise magnesium electrolyte in suitable patients with significant rise seen in serum magnesium. No serious side effects were demonstrated and the readmission rate to hospital was low in our cohort of patients.

References

1. Martinez-Riquelme A, Rawlings J, Morley S, et al. Selfadministered subcutaneous fluid infusion at home in the management of fluid depletion and hypomagnesaemia in gastrointestinal disease. ClinNutr 2005; 24: 158-63.

2. M Small, D Brundrett, J Nightingale. Long term subcutaneous saline and magnesium administration in patients with a short bowel. 10 year outcomes. Gut 2015; 64; a315.