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      Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia

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          Abstract

          Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn's disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfate<sub></sub>was effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia.

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          Most cited references 32

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          Guidelines for management of patients with a short bowel.

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            Causes and management of a high-output stoma.

            Patients with a high-output stoma (HOS) (> 2000 ml/day) suffer from dehydration, hypomagnesaemia and under-nutrition. This study aimed to determine the incidence, aetiology and outcome of HOS.
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              Bayesian hypothesis testing for single-subject designs.

              Researchers using single-subject designs are typically interested in score differences between intervention phases, such as differences in means or trends. If intervention effects are suspected in data, it is desirable to determine how much evidence the data show for an intervention effect. In Bayesian statistics, Bayes factors quantify the evidence in the data for competing hypotheses. We introduce new Bayes factor tests for single-subject data with 2 phases, taking serial dependency into account: a time-series extension of Rouder, Speckman, Sun, Morey, and Iverson's (2009) Jeffreys-Zellner-Siow Bayes factor for mean differences, and a time-series Bayes factor for testing differences in intercepts and slopes. The models we describe are closely related to interrupted time-series models (McDowall, McCleary, Meidinger, & Hay, 1980). (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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                Author and article information

                Journal
                Case Rep Gastroenterol
                Case Rep Gastroenterol
                CRG
                Case Reports in Gastroenterology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH-4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1662-0631
                May-Aug 2019
                26 June 2019
                26 June 2019
                : 13
                : 2
                : 280-293
                Affiliations
                aFaculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
                bDepartment of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
                cDivision of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
                Author notes
                *Dr. M. Makowsky, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3–171 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 (Canada), E-Mail makowsky@ 123456ualberta.ca
                Article
                crg-0013-0280
                10.1159/000501121
                6639584
                Copyright © 2019 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                Page count
                Figures: 2, Tables: 4, References: 35, Pages: 14
                Categories
                Case and Review

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