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| {{Infobox_Disease |
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| Name = Hypomagnesemia |
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| Image = Mg-TableImage.png |
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| Caption = [[Magnesium]] |
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| DiseasesDB = 6469 |
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| ICD10 = {{ICD10|E|83|4|e|70}} |
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| ICD9 = {{ICD9|275.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000315 |
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| MeshID = |
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| }}
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| {{Hypomagnesemia}} | | {{Hypomagnesemia}} |
| | '''For patient information, click [[Hypomagnesemia (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} |
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| {{SK}} Hypomagnesaemia; magnesium levels low (plasma or serum) | | {{SK}} Hypomagnesaemia; magnesium levels low (plasma or serum) |
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| | ==[[Hypomagnesemia overview|Overview]]== |
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| | ==[[Hypomagnesemia pathophysiology|Pathophysiology]]== |
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| | ==[[Hypomagnesemia causes|Causes]]== |
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| | ==[[Hypomagnesemia differential diagnosis|Differentiating Hypomagnesemia from other Diseases]]== |
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| | ==[[Hypomagnesemia risk factors|Risk Factors]]== |
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| ==Clinical Features== | | ==[[Hypomagnesemia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Deficiency of magnesium causes weakness, muscle cramps, [[cardiac arrhythmia]], increased irritability of the [[nervous system]] with tremors, [[athetosis]], jerking, [[nystagmus]] and an extensor [[plantar reflex]]. In addition, there may be confusion, disorientation, [[hallucinations]], [[depression]], epileptic fits, [[hypertension]], [[tachycardia]] and [[tetany]].
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| ==Investigations== | | ==Diagnosis== |
| The diagnosis can be made by finding a [[plasma]] magnesium concentration of less than 0.7mmol/l. Since most magnesium is intracellular, a body deficit can be present with a normal plasma concentration.
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| In addition to hypomagnesemia, up to 40% cases will also have hypocalcemia while in up to 60% of cases, hypokalemia will also be present.
| | [[Hypomagnesemia history and symptoms|History and Symptoms]] | [[Hypomagnesemia physical examination|Physical Examination]] | [[Hypomagnesemia laboratory findings|Laboratory Findings]] | [[Hypomagnesemia electrocardiogram|Electrocardiogram]] | [[Hypomagnesemia other diagnostic studies|Other Diagnostic Studies]] |
| The [[ECG]] shows a prolonged QT interval.
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| ==Treatment== | | ==Treatment== |
| Treatment of hypomagnesemia depends on the degree of deficiency and the clinical effects. Oral replacement is appropriate for patients with mild symptoms, while intravenous replacement is indicated for patients with severe clinical effects. Intravenous magnesium sulphate (MgSO<sub>4</sub>) can be given in the following conditions:
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| ===[[Arrhythmia]]===
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| Magnesium is needed for the adequate function of the [[Na+/K+-ATPase|Na<sup>+</sup>/K<sup>+</sup>-ATPase]] pumps in the cells of the [[heart]]. A lack of it depolarises and results in tachyarrythmia. Magnesium inhibits release of [[potassium]], a lack of magnesium increases loss of potassium. Intracellular levels of potassium decrease and the cells depolarise. [[Digoxin]] increases this effect. Both digoxin and hypomagnesemia inhibit the Na-K-pump resulting in decreased intracellular potassium.
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| Magnesium intravenously helps in refractory arrhythmia, most notably [[torsade de pointes]]. Others are [[ventricular tachycardia]], [[supraventricular tachycardia]] and [[atrial fibrillation]].
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| The effect is based upon decreased excitability by depolarisation and the slowing down of electric signals in the AV-node. Magnesium is a negative inotrope as a result of decrease calcium influx and calcium release from intracellular storage. It is just as effective as [[verapamil]]. In [[myocardial infarction]] there is a functional lack of magnesium, suppletion will decrease mortality.
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| ===Obstetric===
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| Most importantly [[pre-eclampsia]]. It has an indirect antithrombotic effect upon thrombocytes and the endothelial functions (increase in [[prostaglandin]], decrease in [[thromboxane]], decrease in [[angiotensin II]]), microvascular leakage and vasospasm through its function similar to [[calcium channel blocker]]s.
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| [[Convulsion]]s are the result of cerebral vasospasm. The vasodilatatory effect of magnesium seems to be the major mechanism. | | [[Hypomagnesemia medical therapy|Medical Therapy]] | [[Hypomagnesemia primary prevention|Primary Prevention]] | [[Hypomagnesemia secondary prevention|Secondary Prevention]] | [[Hypomagnesemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hypomagnesemia future or investigational therapies|Future or Investigational Therapies]] |
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| ===Electrolyte disturbances=== | | ==Case Studies== |
| *[[Hypokalemia]]: 42% of patients with hypokalemia also have hypomagnesemia, not responding to potassium supplementation. Magnesium is needed for the ATPase, Na-K-pump.
| | [[Hypomagnesemia case study one|Case #1]] |
| *[[Hypocalcemia]] is present in 33% of patients in the intensive care unit, not responding to calcium supplementation. This is because of decreased function of the calcium pump, but also because of a decreased release of calcium by inhibition of [[parathyroid hormone]] release.
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| ===Pulmonary===
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| Acute [[asthma]], here there is a bronchodilatatory effect, probably by antagonizing a calcium-mediated constriction. Also, adrenergic stimulation, i.e. sympatheticomimetics used for treatment of asthma, might lower serum levels of magnesium, which must therefore be supplemented.
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| [[Sedation]] and [[anxiolytic]]s may help in decreasing [[bronchoconstriction]].
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| ==References==
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| #[http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine]
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| #[http://books.mcgraw-hill.com/getbook.php?isbn=0071391401 Harrison's Principles of Internal Medicine]
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| #[http://www.lww.com/product/?0-7817-3548-3 Intensive Care Medicine by Irwin and Rippe]
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| #[http://www.lww.com/product/?0-683-05565-8 The ICU Book by Marino]
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| #[http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine]
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| #Saeed M.G. Al-Ghamdi, Eugene C. Cameron, MD and Roger A.L. Sutton, "Magnesium Deficiency: Pathophysiology And Clinical Overview", ''American Journal Of Kidney Diseases'', 1994; 24 (5), 737-752.
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| #Delhumeau, J.C. Granry, J.P. Monrigal, F. Costerousse, "Indications Du Magnésium En Anesthésie-Réanimation", ''Annales Francaises D'Anesthésie Et De Réanimation'', 1995; 14, 406-416.
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| #J. Durlach, V. Durlach, P. Bac, M. Bara and A. Gulet-Bara, "Magnesium And Therapeutics", ''Magnesium Research'' 1994; 7 (3-4), 313-328.
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| #Mark D. Faber, Warren L. Kupin, Charles W. Heilig and Robert G. Narins, "Common Fluid-Electrolyte and Acid-Base Problems In The Intensive Care Unit: Selected Issues", ''Seminars In Nephrology'' 1994; 14 (1), 8-22.
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| #Lee Goldman, J. Claude Bennett, ''Cecil's Textbook of Medicine'', 21st Edition, 2000, 1137-1139.
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| #Paul L. Marino, ''The ICU Book'', Second Edition 1998, Chapter 42, 660-672.
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| #A.E. Meinders, Professor of Internal Medicine at Leids Universitair Medisch Centrum, "Magnesium", ''Bij Intensive Care Patiënten''
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| #R. Mills, M. Leadbeater and A. Ravalia, "Case Report: Intravenous Magnesium Sulphate In The Management Of Refractory Bronchospasm In A Ventilated Asthmatic", ''Anaesthesia'', 1997; 52, 782-785.
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| #Michael A. Olerich, MD; Robert K. Rude, MD, "Should We Supplement Magnesium In Critically Ill Patients?", ''New Horizons'', 1994; 2 (2),186-192.
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| #James G. Ramsay, MD, "Cardiac Management In The ICU", ''Chest'', 1999; 115: 138S-144S.
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| #Richard A. Reinhart, MD, "Magnesium Deficiency: Recognition And Treatment In The Emergency Medicine Setting", ''American Journal Of Emergency Medicine'', 1992; 10 (1), 76-83. | |
| #Richard A. Reinhart, MD; Norman A. Desbiens, MD, "Hypomagnesemia In Patients Entering The ICU", '' Critical Care Medicine'', 1985; 13 (6), 506-507.
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| #Elisabeth Ryzen, MD; Park W. Wagers, MD; Frederick R. Singer, MD; Robert K. Rude, MD, "Magnesium Deficiency In A Medical ICU Population", ''Critical Care Medicine'', 1985; 13 (1), 19-21.
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| #Elisabeth Ryzen, MD, "Magnesium Homeostasis In Critically Ill Patients", ''Magnesium'', 1998; 8, 201-212.
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| #Robert Whang, Edward M. Hampton and David D. Whang, "Magnesium Homeostasis And Clinical Disorders Of Magnesium Deficiency", ''The Annals Of Pharmacotherapy'', 1994; 28, 220-226.
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| #[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7766029 Selenium deficiency as a cause of overload of iron and unbalanced distribution of other minerals]
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| ==Related Chapters== | | ==Related Chapters== |
| * [[Hypermagnesemia]] | | * [[Hypermagnesemia]] |
| * [[Hypomagnesemia with secondary hypocalcemia]] | | * [[Hypomagnesemia with secondary hypocalcemia]] |
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| ==External links==
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| *[http://ods.od.nih.gov/factsheets/magnesium.asp Magnesium ]
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| *[http://www.webelements.com/webelements/elements/text/Mg/index.html WebElements.com – Magnesium]
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| *[http://www.ctds.info/5_13_magnesium.html Magnesium Deficiency]
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| *[http://www.ars.usda.gov/is/AR/archive/may04/energy0504.htm Lack Energy? Maybe It's Your Magnesium Level]
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| *[http://www.iom.edu/Object.File/Master/7/294/0.pdf Dietary Reference Intake]
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| {{Endocrine, nutritional and metabolic pathology}} | | {{Endocrine, nutritional and metabolic pathology}} |
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| [[de:Magnesiummangel]] | | [[de:Magnesiummangel]] |
| [[pl:Hipomagnezemia]] | | [[pl:Hipomagnezemia]] |
| [[Category:Inborn errors of metabolism]]
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