Hypomagnesemia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood. Usually a serum level less than 0.7 mmol/l is used as reference. It must be noted that hypomagnesemia is not equal to magnesium deficiency. Hypomagnesemia can be present without magnesium deficiency and vice versa.
It may result from a number of conditions including inadequate intake of magnesium, chronic diarrhea, malabsorption, alcoholism, chronic stress, diuretic use and other disorders.
Historical Perspective
The prefix hypo- means low (contrast with hyper-, meaning high). The middle magnes refers to magnesium. The end portion of the word, -emia, means 'in the blood' (note, however, that hypomagnesemia is usually indicative of a systemic magnesium deficit).
Classification
Pathophysiology
Causes
Magnesium deficiency is not uncommon in hospitalized patients. Elevated levels of magnesium (hypermagnesemia), however, are nearly always iatrogenic. 10-20% of all hospital patients, and 60-65% of patient in the intensive care unit (ICU) have hypomagnesemia. Hypomagnesiemia is underdiagnosed, as testing for serum magnesium levels is not routine. Hypomagnesemia results in increased mortality. Causes of hypomagnesemia can be Alcoholism, Diuretic use, Antibiotics, stress, Gastrointestinal causes, Diabetes mellitus, Malabsorption, and Acute pancreatitis
Differentiating Hypomagnesemia from other Diseases
Hypomagnesemia should be differentiated from other causes of abnormal parathyroid hormone levels for example, hypoparathyroidism (genetic and idiopathic), acrodysostosis and pseudohypoparathyroidism.
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
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.
Physical Examination
Laboratory Findings
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. In addition to hypomagnesemia, up to 40% cases will also have hypocalcemia while in up to 60% of cases, hypokalemia will also be present.
Electrocardiogram
The EKG shows a prolonged QT interval.
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings