665
NOVÁ3518200011159120179233
DOPORUČENÍ3777200011159121174237296355412467529562
/4365200011132
NEW4422200011159115199
RECOMMENDATIONS4647200011157113170232307382438500563621675708769831880
Význam33903200974584120166205272
sledování3679320097325192138183221261306325
ionizované40213200971963109128163207246285330371
frakce4409320097235190128164204
magnezia463032009766106151196237272292331
v497832009738
intenzivní5033320097196490130176211230269315334
péči53843200974687124143
|5584190011126
51565419001114382
/24408040010732
Anest25178040010752100145178207
intenziv274480400107196794136184221240282
Med.30458040010770115165181
2026;37(1):50-533245804001074487129171186230271291331348363407450480523565
/38558040010731
ANESTEZIOLOGIE39528040010752112155200245290342362424467527586607650
A46248040010752
INTENZIVNÍ4698804001071978123168226276296345405426
MEDICÍNA51458040010770114173195248268327381
www.aimjournal.cz4258040010765133201214257275349367415463490539579598614654693
Monitoring4255200166108176253295345415476519598664
of1113520016667115
ionized1252520016641108185227289353428
magnesium17045200166110176242322384441482557668
and2396520016665145218
its263852001664191149
importance2811520016640152225294355410477557617681
for3516520016648115176
the3716520016652130193
critically3933520016660122165216257318384426468532
ill448952001664083125
Expert425670016374141214275329378
consensus829670016359125198253315387443516571
statement1426670016354100164207269377436509553
of2005670016365106
the2137670016346121180
Czech2344670016378138199259333
Society2703670016369134194232291337398
of3128670016365105
Intensive3260670016342116160222295350387447507
Care3793670016378140197259
Medicine,40786700163108167238277335373448508540
the425810016345120180
Czech632810016378138199259332
Society991810016368134194232291336398
of1416810016364105
Anaesthesiology,1547810016382159222281336383458517572609673707771832897922
Resuscitation2495810016380143198271326386423467531574613677749
and3271810016361137206
Intensive3503810016343117161223295351388448508
Care4037810016378140197258
Medicine,43228100163108167238277335372448508539
and425950016361137206
the658950016345120180
Czech864950016379139200260333
Society1224950016368134194232291336398
of1648950016365106
Clinical1780950016378115154230269326389428
Biochemistry2234950016375111174234308367475514569616671736
Ionised425115001212480136159199250307
magnesium7611150012184132189244295335358413497
(Mg2+)1286115001212910816514501160071306515131150012129
represents1570115001213383141174224264315371403444
biologically2043115001215781136161216273297342391415438486
active2557115001214994129153201251
form2836115001213085118203
of3067115001215585
total3180115001213488121170194
plasmatic3403115001215781129169252301334357402
magnesium38341150012183132188244295335358413496
and43591150012148104161
an45491150012148104
essential4681115001215191130181237270293341365
electrolyte5074115001215175126172207240295319367404453
with425129001217498132187
an6411290012148104
impact7741290012123107164213259294
on10971290012155111
cellular1237129001214595119142198221270303
functions,1568129001212986142187223246302358397419
metabolism,20151290012184135169218276332356379419503524
creation2567129001214578128177210233289345
of2940129001215685
energy30541290012150106157191247295
substrates3378129001213994152191226258307340390430
(ATP),3837129001212889133187213232
myocardial40971290012184130185231280313370393442465
electrical4591129001215075125172207240264309358382
stability5002129001214074123180204228251285335
and53651290012149105162
the425143001213388139
neuromuscular5881430012156106161194249332387426471526549597630
transmission.1243143001213365114169208291314353392415470526547
Critically1815143001215890113146169214263286309357
ill219614300121244770
patients22911430012157105138161211267299340
face2655143001213079123172
significant2852143001214062118174197226252297346401433
changes33101430012145100148203259309349
in3684143001212378
acid-base3787143001214893116172204262311350400
regulation,4212143001213383139194217265298321376432452
distribution4689143001215680119153185209265321354377432488
of5201143001215584
body53101430012157112170217
fluids425157001212956110133190229
and6731570012149104161
hormonal8531570012155110143227282338386409
regulations,1282157001213282139194217265298321376431470492
which17931570012173129152197252
render2064157001213383138195245278
traditional2361157001213466115171194228251306361409433
estimates2813157001215090123146230278310359399
of3231157001215584
total3334157001213387120169193
magnesium35461570012183131187242293332355410493
levels4058157001212474122171195234
insufficiently4311157001212479118172202234260305328378434466490537
informative4867157001212479108163196279327360383431480
and53671570012148103160
potentially4251710012157113146195251283306354377400448
misleading.8921710012184107146169220268324348403459480
This13911710012150106129168
collaborative1579171001214598123146194250306339387420443491540
intersocietal2139171001212378111160193233289334357407441490513
position26721710012156112152175208231286341
statement3033171001214073122155204288338394426
summarizes3479171001213994177260308341364407457496
current39951710012145100132165215271303
state-of-the-art4317171001214074123155205238296325354387442493526574607642
scientific4979171001214085108158214246269298324369
and53681710012148103160
clinical42518500121446789144166211258281
experiences,724185001214996152203235258307362407455494514
resulting1256185001213281120173196229251306361
in1634185001212378
recommendations1729185001213281126179262344394449504552584606660715754
for2500185001212983115
introduction2633185001212377109141195251305349384406461515
of3166185001215483
a32661850012148
routine3331185001213286141173196250300
Mg2+36481850012180135378218600713063
measurement38631850012183132180218272304353435485540572
in4452185001212378
the4547185001213387137
critical470118500121447699132154198246269
care4987185001214593125174
practice.5178185001215689136180215238282330350
An4251990012161115
availability557199001214894142164187234290313336358391440
of1014199001215583
Mg2+11141990012180136124820000713063
measurement13281990012183132180218272304353435485540572
in1917199001212378
selected2012199001213989112162207241290347
groups2376199001215587141195251290
of2683199001215583
patients27831990012157105137159209263295335
is3135199001212462
desirable32141990012156106145167199246302326376
in3607199001212377
relation3702199001213281105152184206260315
to4035199001213286
new41381990012155105177
methods43321990012183133165220274330369
in4718199001212378
the4813199001213387137
intensive4967199001212378109158213251274321370
care5354199001214492124173
practice425213001215789138182217240285334
and7762130012148103160
is953213001212463
considerably1033213001214599154193216272322355403459483530
supported1581213001214094150207263295331380437
by20362130012157103
the2157213001213388138
known23122130012147104159231287
deficit26172130012156106136162206229262
of2897213001215483
magnesium29982130012183131187242292331354408491
in3507213001212378
the3603213001213388138
general37592130012155106161211244292315
population.40922130012157113169225248296328351405461482
The45922130012149105156
Mg2+47652130012180137490121400713064
estimates4983213001215089123146229276309358397
are5398213001214880130
suitable425227001214094117150199256280330
for778227001213085117
the919227001213388138
intensive1080227001212479111161216255278326376
care1479227001214493126175
units16782270012155110133166207
and19082270012148103160
the2091227001213388139
critically2253227001214577101134157202250274297344
ill262022700121244770
in2713227001212479
Czechia.28152270012158103153198253277324346
The31842270012149106156
prominent3363227001215790145228252307357413445
indications3831227001212479136159203252285308363418457
are4312227001214880130
especially4465227001215090146197243266314337360408
regional4896227001213382139162217273321345
citrate5264227001214467100133182214263
anticoagulation4252410012148102134157201254302358412435482514537591647
and10892410012148102158
renal1265241001213282137184207
failure,1490241001212977100123177209258277
in1785241001212378
patients18802410012157105137159209264296336
with2234241001217396129183
heart24352410012155104152184219
failure2672241001212977100123177209258
and29482410012148102158
a31242410012147
risk318924100121325594140
of3347241001215483
arrhythmias3447241001214880113168213249303385408455494
including3959241001212377122144199255277332387
perioperative43642410012156107139162217273324356404436459507555
arrhythmias4937241001214779112167212248302385407455493
at5448241001214880
the425255001213388138
complex581255001214599182238262313360
cardiovascular959255001214493125181204259306355394438493516564597
centres.1573255001214594150182214264303324
Furthermore,19152550012149102134170225275308391446479529549
the2482255001213388138
measurements26382550012183134182221275307357440491546578619
are3275255001214880130
recommended3423255001213282128181265348398454510560617
in4058255001212479
diabetic4155255001215679127183234267290335
and45082550012148103160
septic4685255001214090147180203248
patients.49512550012156105137160210266298339360
Mg2+53292550012180136546425600713064
should425269001214095149205228284
be7272690012157107
taken852269001213382128177233
everywhere1102269001215098147180230306362412445495
in1614269001212479
shock1710269001214095150195242
accompanied1969269001214893137190273330379434457507564
with2551269001217397129184
significant2753269001214062118173196225252296345400432
shifts3203269001213994117147183223
in3444269001212378
body35402690012157112169217
fluids3775269001212955109133189228
and40212690012148103159
acid-base4198269001214893116172204262310349399
regulation4615269001213382139194217265297320375430
associating5063269001214887126181227249297329352407463
with425283001217497130186
a6312830012148
positive6992830012157113152175208231279328
balance10472830012157106129177233278327
of1394283001215484
fluids1498283001212955110133190229
followed1747283001212984108131186259309366
by21332830012157103
a22562830012149
de-resuscitation23252830012156106140173223263317356401424457506539562617673
phase30182830012156112160200250
and32882830012148104160
a34682830012148
subsequent3536283001214094151190241298353403459491
fluid4047283001212956110134190
elimination.425728300121507497180204259307339362417473494
The47712830012150106157
measurement49482830012183134182221275308358441492547580
should425297001214095150205229285
be7312970012157108
available860297001214995144167190238295319369
24/712502970012152100134186
as1457297001214888
part15662970012157105138174
of1761297001215584
the1866297001213388139
point-of-care20262970012157113136191224252309338368415464496546
analysis25932970012148104152175223262285324
similarly2938297001214063146169192240273297344
as3303297001214887
the3412297001213388138
level3572297001212374121170194
of3787297001215584
ionised3893297001212378134157196246304
calcium4218297001214593117162185239323
(Ca2+).45622970012128841324694298007130644757297001212847
Key4253140012358108158
words:6033140012375131167225267290
magnesium,9153140012183132187243293333356410493514
ionised1450314001212479134158197247304
magnesium,17763140012183131187242293332355410493514
intensive2311314001212379111160216255278326375
care,2707314001214594126176196
regional2924314001213383140163218274322345
citrate3290314001214568101133182215264
anticoagulation,35753140012148103136159204257306362417440488521544599654675
arrhythmias,4271314001214981114170215252307390413461500521
heart48133140012156106154187223
failure.5057314001212978101125179212262282
Úvod4253660015378141206278
a7263660015362
fyziologie8113660015347112170211276315379442483543
homeostázy13773660015373137240299365419472536594658
magnezia205836600153102166230304364420461526
Magnezium4253840010770111160208253290309356430
je876384001071963
kofaktorem960384001073885109151189220267294336410
více1391384001074160100143
než1554384001074993130
3001705384001074487133
enzymatických1859384001074391128171246287314333373411454493541
reakcí,2421384001072770110148187206221
včetně2663384001074080122150198242
tvorby425398001072770116142191229
ATP,669398001075287132136
moduluje8213980010772119168214232278297339
iontové1176398001071865112138183222264
kanály1456398001073778125165183221
a16933980010740
je1748398001071962
nezbytné1825398001074891127176214244291334
pro2175398001074874120
udržení2311398001074795120157199246264
normální2590398001074794120193233251297315
neuromuskulární425412001074993142168216291339373411460479520547596615
excitability,1067412001074484124143171213263283302321349392404
aktivitu1498412001074180111130172191220268
Na+/K+-ATPázy,17934120010758991893411007135192941200107327820074110071352043412001072780117164204242286297
regulaci2367412001072770121169188230271290
srdečního2683412001073461109154196425426001074867117165
rytmu,616426001072670101175222238
metabolismus8794260010774118146188237286306324357430478511
glukózy1416426001074967115153200235278
a17204260010741
laktátu,178742600107195997128169197245260
tubulární2073426001072876125173192233259308327
funkci2425426001072473121159198217
ledvin.2668426001071963113154173221237
Ionizovaná425440001071967116135171218259300348389
frakce83444000107235192130170212
(Mg2+)106644000107249214212084390071306412704400010724
má13144400010773114
přímý144844000107497695169207
biologický1675440001075069117137185235254294332375
účinek.2069440001074889107155199237255
Mg2+565454001077012068545300713064
jako77145400107196098145
biologicky937454001075069117136185235253294332374
aktivní1332454001074179110129170219238
forma159145400107237198172213
představuje1825454001075076119169202231273312361380424
více2270454001074060100142
než2433454001074993130
polovinu2584454001075099118167207226274322
celkového425468001074083102139187227270319367
plazmatického811468001075070110147222262290308349386429478526
magnezia,13564680010774115164212257294313353369
které1744468001073969112138181
ale1945468001074059103
reprezentuje2068468001072669119146189226269317344392411455
jen2542468001071963111
asi267246800107417493
127844680010744
%28394680010766
celkové425482001074083102140187228271
tělesné72248200107287190134168215260
zásoby,1008482001073679112161211250262
činící1296482001074059107126166184
pouhých1507482001075099147195234274322
118554820010744
0001911482001074489135
mmol,20624820010774148196216231
která2319482001073869112139180
se2526482001073378
nachází2630482001074889130178219256275
intracelulárně42549600107196794120162202245264312330371397446490
(Obr.933496001092686138168183
1).113349600109466611964960010716
Mg2+,1229496001077012013494950071306414124960010716
tj.144549600107284763
přibližně152549600107507696145165183220268312
60–701854496001074489137177219
%20904960010766
bioaktivní2174496001074969117158196227246287336354
frakce254649600107235193131170212
celkového2776496001074082102425510001073885126169217265
magnezia7075100010774115164212256293313353
(Mgtot),1077510001072392141121951600631644611280510001072437
je1334510001071963
vázané1414510001074182119162210254
na1684510001074989
proteiny1790510001075077124151194212260298
a21055100010741
anionty2163510001074189107155204231273
(laktát,245351000107244384122153194221237
citrát,270751000107405987113155182198
fosfát,425524001072471105130172199215
bikarbonát658524001075069107149175225275323364391
atd.).1067524001074168116132154167
Mg2+12525240010770120137252300713064
oproti1455524001074898125172199218
Mg16915240010770120
tot18115300063164461
lépe1890524001071963113158
odráží2066524001074797124165203222
změny23065240010736110154202241
tělesných256552400107277089133167214253292341
bílkovin42553800107506990127175215234282
(hypo/hyperalbuminemie),730538001072372111161210241291329380425451493512561610683702750794867886930951965
acidobazické1717538001074182100149198248289327346386424467
rovnováhy2207538001072673113163211251293341379
(acidóza2609538001072462103121170219254296
↑4255520013442
iMg2+,491552001071989138629551007130646925520010716
alkalóza73155200107405997139158206242284
↓10385520013445
iMg2+),11065520010719891381245551007130641307552001072437
změny13675520010737111155203241
ligandů163155200107193887128176225272
(laktát,192655200107244484122153194221238
citrát,218655200107415987114156183199
bikarbonát…)2408552001074969106149175225274323364391478498
nebo425566001074892142191
třeba64056600107285597147189
vlivy85356600107406079120163
renálního1040566001072669118158177225244294342
selhání140656600107347897145185234252
a16825660010741
náhrady1747566001074889137164205255295
funkce2066566001072372120158198240
ledvin.2330566001071963113155174222238
U25925660010756
těchto2673566001072770111159186232
v4255800010741
intenzivní49258000107196794137185222242283332351
péči869580001075095136155
častých1050580001074182116145187227276
stavů1352580001073463104144193
je1571580001072064
přítomna166158000107507796124171245294334
ve2022580001074184
20–302132580001074588136177221
%23795800010767
diskordance2472580001074968101138186213261302350391434
Mgtot3047370001077012031673760063164461
a32483700010741
Mg2+,3309370001077012034293690071306434923700010716
jinými352837000107193885124199217
slovy3765370001073453101141184
normální3969370001074997124198239258306324
Mg43133700010770120
tot44343760063164461
může45153700010774121158200
maskovat47353700010774115148186233273315342
významnou5097370001074184123172212286334382431
ionizovanou3047384001071967115134171218258299348396444
hypomagnezemii3512384001074886137186260301350398443480523596615634
nebo4166384001074892142191
naopak.4378384001074889137187229267285
V46833840010746
praxi4749384001075077119158177
to4947384001072874
může50423840010774121157200
vést5263384001074084117146
jak543038400107195997
k30473980010739
nehrazení3112398001074994143170212250294343362
skryté3501398001073472101144176220
hypomagnezemie,3747398001074988140190265307357406450488532607626670685
tak4459398001072870109
i45953980010719
k46413980010738
nadbytečné4706398001074990141191231263306348397442
substituci5175398001073481132166195215243292333352
řízené304741200107274682125173218
pouze3284412001075099147184227
Mgtot3531412001077011936514180063164461
(Obr.3732412001092686138168183
1).393441200109476639984120010716
Již318742600107314984
samotná3287426001073374146193220267307
hladina3609426001074866106154172219258
celkového3883426001074081100136182222264311358
magnezia42574260010773113161208251287306345
extrapolovaná4618426001074381111137178226274293340380420467507
z51404260010736
Gaussovy5192426001075595142174206254293335
křivky304744000107386685126165208
v32784400010741
populaci3342440001075099149197216257297316
(0,7–1,1368144000107246782125166204215254
mmol/l)39504400010774147196216248268292
nemusí4266440001074892166213246264
nutně4553440001074996124173217
znamenat4793440001073685126199244292333360
„normální5176440001072676124151225266285333351
úroveň“3047454001074773120160203250273
pro3336454001075076123
správnou3475454001073382109150189238286333
funkci3824454001072472120157196214
všech4055454001074073117158205
homeostatických4277454001074795169213261294323364390409449486529568615
procesů,4909454001074975122163205238284299
a52254540010740
někteří5282454001074791129159201227246
autoři3047468001074087115161187206
doporučují3269468001074896145193220267307354372390
posun3675468001074998131177224
dolní3915468001074996115162181
hranice4112468001074773114161179219261
k43894680010737
0,854442468001074458104146
mmol/l46034680010772145193212244263
[1,488246800109256882
2].497946800109466950464680010716
V50774680010746
populaci5139468001074997147194213253292311
je5466468001071962
chronická,3047482001074086112158205223262299340355
často3418482001073980112140185
normomagnezemická3619482001074895121194241313353401448491527569641659698735776
latentní441148200107195884126173199246264
Mg2+46904820010769118480848100712962
deplece4886482001074891140158201241283
velmi5184482001074083101173191
častá53904820010740801123047496001072869
(odhad3132496001072469119167207256
cca3405496001074078119
45–503541496001074384130173215
%37734960010766
populace3855496001075099148196215255295338
v42094960010741
některých4266496001074892130160202229271311358
zemích).4641496001073679152170210258279292
Přispívá494949600107457189122171190231272
k52374960010738
rozvoji5292496001072673108152199218236
řady3047510001072667115154
neinfekčních3217510001074891109156179221258296343361401448
chronických3680510001074087112158206224263300342381428
onemocnění4124510001074794138210257298345388435453
(hypertenze,4592510001072472109159203228259300347383425439
ICHS,5047510001071969124164179
arytmie,5242510001074065108138211228271285
plicní304752400107506988128176195
hypertenze,3268524001074887137182208239282330367410424
migréna,3718524001077493142168211259300316
epilepsie,4060524001074493112131175225258276320335
deprese,4421524001074993142169212246290305
osteoporóza…).4752524001074881110153202252301328375410452540559572
Řada5350524001074687137177
pacientů3047538001075091132150194242269317
přichází338653800107497695136184224261281
do3688538001074998
intenzivní380753800107196794136185222241282331349
péče4178538001075095136178
již437853800107193874
s44745380010733
chronickou4529538001074088115162210229269307354402
latentní495353800107196087129178204253271
deplecí,5246538001074993143162206248266281
kdy3047552001073886125
sérové3189552001073377103149189232
hodnoty3437552001074896145193240267309
mohou37635520010773121169217264
být4044552001074988119
ještě417955200107196295124166
v43615520010740
normě,4417552001074896123196240254
ale4687552001074159103
intracelulární480655200107196692119160200242261308326366392440459
zásoby5281552001073678110158208247
jsou3047566001071952100148
výrazně3211566001074184111152189238282
snížené.3509566001073481100136179226270285
V38115660010745
takovém3873566001072769106153193236310
terénu419956600107287096139187234
může44505660010773120157199
regionální4666566001072669119137185233274292340358
citrátová504156600107405886113154181227267309
antikoagulace53665660010741891151343047580001073885127176224243283324366
(RCA),3435580001072469121175199212
diuretika3669580001074968115141184212231269311
nebo4002580001074892142191
kritický421558000107386685113132172210253
stav4490580001073362104143
deficit4655580001074993117137177196224
rychle4900580001072770110158177221
prohloubit5142580001075077124173192240288338357385
Obr.4256060012566121167189
1.630606001255478
Distribuce753608001075675105131156175220266303339
tělesného110960800107266280118150195233279324
magnezia14496080010772117162209247284302347
v18126080010738
organismu1866608001074571114159206224253323368
v22516080010737
procentech2305608001074571115153189236261297335381
(přibližně270260800107246995113158176195229275313
130326080010741
0003084608001074285128
mmol32286080010772143188207
celkem)345160800107377492129166238259
Intracelulární24306490095176084108146182220238280297334357401418
pool286664900954488132150
magnezia3033649009566102146189229263280316
99336764900953979
%3463649009559
Mg2662681009562107
ve278668100953675
svalech287968100953067104122161198241
27313868100953976
%3231681009559
Mg1571681009562107
v1695681009536
kostech174968100953476106132171208251
53201768100953976
%2111681009559
Mg3761681009562107
v3885681009536
měkkých3939681009565105139175213249292
tkáních42486810095255997140157193236
19450268100953973
%4592681009559
Mg2759730009562107
v2883730009536
krvi29377300095345998116
13071730009539
%,312073000955974
z2701740009532
toho275174000952466110153
67292274000953976
%3008740009559
Mg2+,30857400095621063191740005623493238740009514
protein265075000954468111135173190233
vázané290175000953673107145188227
19314675000953973
%,322975000955974
v2670760009536
komplexech272476000953476142187204244279318355398
14313976000953975
%3224760009559
Renální383873600954080123160177220237
reabsorpce38387460095246298143173216240286323361
a3838756009536
exkrece389275600953974109134173210248
Intestinální17637360095176084122153179196239275292335352
absorpce181674600953681111154179224261299
a1878756009536
ztráta19327560095326084121146183