Study the Effect of Serum Magnesium Level on Chemotherapy Induced Peripheral Neuropathy

TL;DR: Taxanes and Vinca alkaloids have an effect on serum magnesium level but in combination with platinum compounds there was a further decrease in the magnesium level so the combination therapy using multiple compounds and its effect in serum level requires further exploration.

Abstract: Introduction: Magnesium, the second most abundant intracellular cation in the body, required for cellular energy metabolism and has an important role in membrane stabilization, nerve conduction, ion transport, and calcium channel activity. Manifestation of magnesium deficiency includes numbness, tingling, muscle contractions and cramps, seizures (sudden changes in behaviors caused by excessive electrical activity in the brain), personality changes, abnormal heart rhythms, and coronary spasms can occur. Materials and Method: The patient’s history and clinical examination were recorded followed by prechemotherapy baseline serum magnesium level using validated analyzer (Cobas Integra 400 plus) in biochemistry lab using the same serum which was separated from patient’s drawn venous blood on which serum creatinine was routinely performed avoiding the need to draw extra blood for this test. After determining the serum Magnesium result, treating nurse gave MgSO4 (50% 01mg/2ml) and KCL (15% 1.5 mg/10ml) to the patient as a premedication to avoid the side effects resulting from chemotherapy. Result and Discussion: The data from the study did not yield significant result to support the effect of Magnesium on CIPN but the gradual decrease in the mean serum magnesium level does warrant further exploration on large population to review hypomagnesemic symptom. In this study baseline value for male and female were Mean ± SEM, 2.046 ± 0.008350 (N=20) and 2.038 ± 0.004787 N=12 respectively with P value of 0.4903. Furthermore premagnesium level for 2nd cycle Mean ± SEM= 1.970 ± 0.007255 N=20 (male) and 1.980 ± 0.01285 N=12 (female) ,3rd cycle Mean ± SEM= 1.929 ± 0.009383 N=20 (male) and 1.921 ± 0.008657 N=12 (female), 4th cycle Mean ± SEM= 1.891 ± 0.009907 N=20 (male)and 1.888 ± 0.02229 N=12 (female), 5th cycle Mean ± SEM= 1.836 ± 0.01080 N=20 (male) and 1.873 ± 0.05166 N=11 (female), and 6th cycle Mean ± SEM= 1.828 ± 0.04453 N=9 (male) and 1.833 ± 0.08750 N=4 (female) and the P value for 2nd, 3rd, 4th,5th, and 6th cycle were 0.4688, 0.5848, 0.9200, 0.3658, and 0.9581 respectively. Above results show that the pre-magnesium level for 2nd , 3rd , 4th, cycle for both sex group were nearly same but before 5th cycle mean serum magnesium level in males were lower compared to their female counterpart. Conclusion: In conclusion, Taxanes and Vinca alkaloids have an effect on serum magnesium level but in combination with platinum compounds there was a further decrease in the magnesium level so the combination therapy using multiple compounds and its effect on serum level requires further exploration. Due to limited patient population, there was no significant data to support the effect on magnesium level. Moreover, clinical examination is not an effective method for evaluation for CIPN. So there is stringent need to evaluate the effect of serum Magnesium level in larger cancer population. NCS (Nerve conduction study) will need to be carried out for CIPN assessment to give the precise result.