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| __NOTOC__
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| {{CMG}}; {{AE}}
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| ==Overview==
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| '''Magnesium deficiency''' or '''hypomagnesia''' (not to be confused with [[hypomagnesemia]]) refers to inadequate intake of [[dietary magnesium]] or impaired absorption of magnesium, which can result in numerous symptoms and diseases.<ref>{{cite web|title=Definition of Magnesium Deficiency|url=http://www.medterms.com/script/main/art.asp?articlekey=4244|publisher=MedicineNet.com|accessdate=31 May 2014}}</ref> It is generally corrected by an increase of magnesium in [[diet (nutrition)|diet]], oral supplements, and in severe cases, intravenous supplementation.
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| ==Historical Perspective==
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| Magnesium deficiency in humans was first described in the medical literature in 1934.<ref>{{cite journal|last1=Hirschfelder|first1=A. D.|last2=Haury|first2=V. G.|title=Clinical Manifestations of High and Low Plasma Magnesium; Dangers of Epsom Salt Purgation in Nephritis|journal=Journal of the American Medical Association|date=1934|volume=102|page=1138|doi=10.1001/jama.1934.02750140024010 }}</ref>
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| ==Classification==
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| ==Pathophysiology==
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| [[Magnesium]] is a co-factor in over 300 functions in the body regulating many kinds of biochemical reactions. It is involved in [[protein synthesis]], muscle and nerve functioning, bone development, energy production, the maintenance of normal heart rhythm, and the regulation of [[glucose]] and [[blood pressure]], among other important roles.<ref name=factsheet>{{cite web|title=Magnesium: Fact Sheet for Health Professionals|url=http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#en3|website=nih.gov|publisher=National Institutes of Health|accessdate=8 November 2014}}</ref> Low magnesium intake over time can increase the risk of illnesses, including [[hypertension|high blood pressure]] and [[cardiovascular disease|heart disease]], [[diabetes mellitus type 2]], [[osteoporosis]], and [[migraine]]s.<ref name=factsheet>{{cite web|title=Magnesium: Fact Sheet for Health Professionals|url=http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#en3|website=nih.gov|publisher=National Institutes of Health|accessdate=8 November 2014}}</ref>
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| ==Causes==
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| Causes of magnesium deficiency include diet, alcohol abuse, chronic stress, poorly controlled diabetes, excessive or chronic vomiting and/or diarrhea. Phytate<ref name="pmid6747725">{{cite journal|last=Forbes|first=RM |author2=Parker, HM |author3=Erdman JW, Jr|title=Effects of dietary phytate, calcium and magnesium levels on zinc bioavailability to rats.|journal=The Journal of Nutrition|date=Aug 1984|volume=114|issue=8|pages=1421–5|pmid=6747725|url=http://jn.nutrition.org/content/114/8/1421.full.pdf}}</ref> or [[oxalate]]<ref name="Great Plains Labs - oxalates">[http://www.greatplainslaboratory.com/home/eng/oxalates.asp Oxalates may absorb magnesium], background information indicating possibility of oxalates absorbing magnesium.</ref> in the diet may bind magnesium causing it to be eliminated from rather than absorbed in the colon. Certain drugs can deplete magnesium levels such as [[osmotic diuretic]]s, [[cisplatin]], [[ciclosporin]], [[amphetamine]]s, and possibly [[proton pump inhibitor]]s.<ref name=fda>{{cite web|title=FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)|url=http://www.fda.gov/drugs/drugsafety/ucm245011.htm|website=fda.gov|publisher=F.D.A. U.S. Food and Drug Administration|accessdate=8 November 2014}}</ref> Also deficiency may occur in [[Bartter syndrome]]<ref name=bartter>{{cite journal|last1=Rodríguez-Soriano|first1=Juan|title=Bartter and related syndromes: the puzzle is almost solved|journal=Pediatric Nephrology|date=May 1998|volume=12|issue=4|pages=315–327|doi=10.1007/s004670050461|url=http://link.springer.com/article/10.1007%2Fs004670050461|accessdate=8 November 2014|pmid=9655365}}</ref> and [[Gitelman syndrome]].<ref name=gitelman>{{cite journal|last1=Simon|first1=DB|last2=Nelson-Williams|first2=C|title=Gitelman's variant of Bartter's syndrome, inherited hypokalaemic alkalosis, is caused by mutations in the thiazide-sensitive Na-Cl cotransporter|journal=Nat Genet|date=January 1996|volume=12|issue=1|pages=24–30|pmid=8528245|url=http://www.ncbi.nlm.nih.gov/pubmed?term=david%20b%20simon%20gitelman%27s%20variant|accessdate=8 November 2014|doi=10.1038/ng0196-24|display-authors=etal}}</ref>
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| ==Differentiating {{PAGENAME}} from Other Diseases==
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| ==Epidemiology and Demographics==
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| 57% of the US population does not meet the US [[Dietary Reference Intake|RDA]] for dietary intake of magnesium.<ref>{{cite web |url=http://www.ars.usda.gov/Services/docs.htm?docid=15672 |title=Nutrient Intakes Percent of population 2 years old and over with adequate intakes based on average requirement |accessdate=2012-02-11 |date=2009-07-29 |work=Community Nutrition Mapping Project}}</ref> The kidneys are very efficient at maintaining body levels, except in cases where the diet is deficient due to the use of certain medications such as [[proton-pump inhibitor]]s<ref name=fda>{{cite web|title=FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)|url=http://www.fda.gov/drugs/drugsafety/ucm245011.htm|website=fda.gov|publisher=F.D.A. U.S. Food and Drug Administration|accessdate=8 November 2014}}</ref> or [[chronic alcoholism]].<ref name=factsheet>{{cite web|title=Magnesium: Fact Sheet for Health Professionals|url=http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#en3|website=nih.gov|publisher=National Institutes of Health|accessdate=8 November 2014}}</ref>
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| ==Risk Factors==
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| ==Screening==
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| ==Natural History, Complications, and Prognosis==
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| ===Natural History===
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| ===Complications===
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| ===Prognosis===
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| ==Diagnosis==
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| ===Diagnostic Criteria===
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| ===History and Symptoms===
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| Symptoms of magnesium deficiency include hyperexcitability, muscular symptoms (cramps, tremor, [[fasciculation]]s, spasms, [[tetany]], [[muscle weakness|weakness]]), [[Fatigue (medical)|fatigue]], [[anorexia (symptom)|loss of appetite]], apathy, confusion, [[insomnia]], irritability, poor memory, and reduced ability to learn. Moderate to severe magnesium deficiency can cause tingling or numbness, heart changes, [[tachycardia|rapid heartbeat]], continued muscle contractions, [[nausea]], [[vomiting]], personality changes, [[delirium]], hallucinations, [[hypocalcemia|low calcium levels]], [[Hypokalemia|low serum potassium levels]], retention of sodium, low circulating levels of [[parathyroid hormone]] (PTH),<ref>Rude RK, Shils ME. Magnesium. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease. 10th ed. Baltimore: Lippincott Williams & Wilkins; 2006:223-247</ref> and potentially death from heart failure.<ref>{{cite book|last=Blaylock|first=Russell L.|title=Health and nutrition secrets that can save your life|year=2006|publisher=Health Press|location=Albuquerque, NM|isbn=978-0-929173-48-1|page=395}}</ref> Magnesium plays an important role in carbohydrate metabolism and its deficiency may worsen [[insulin resistance]], a condition that often precedes diabetes, or may be a consequence of insulin resistance.<ref name="pmid2255809">{{cite journal|last=Kobrin|first=SM|author2=Goldfarb, S|title=Magnesium deficiency.|journal=Seminars in nephrology|date=Nov 1990|volume=10|issue=6|pages=525–35|pmid=2255809}}</ref><ref>{{MedlinePlus|002423|Magnesium in diet}}</ref>
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| ===Physical Examination===
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| Diagnosis of severe hypomagnesemia can be made through a standard serum magnesium test. The accuracy of the serum magnesium blood test as an indicator of overall magnesium sufficiency is disputed due to claims that the total percentage of magnesium stored freely in the blood is less than 1%.
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| ===Laboratory Findings===
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| ===Imaging Findings===
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| ===Other Diagnostic Studies===
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| ==Treatment==
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| ===Medical Therapy===
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| Magnesium deficiency can often be effectively treated with an [[oral magnesium preparation]]. It can also be treated by using a nebulizer filled with magnesium sulphate or magnesium chloride dissolved in water. Nebulising has the advantage of taking effect within minutes, relieving muscle pain, tension or breathing difficulties. Nebulizers can be bought without prescription in the U.K, as can magnesium sulphate and magnesium chloride. For those that require frequent doses, a portable, battery driven nebulizer is useful although more expensive and prone to break down than older style plug in nebulizers.
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| [[Probiotic]] lactobacilli, and other species of endogenous digestive microflora ''may'' play a role in the bioavailability of magnesium as they may affect the breakdown of antagonists such as [[Phytic acid|phytate]] and [[oxalate]] in the diet. Other minerals in the diet, such as calcium and zinc, may interact with phytate and oxalate, reducing magnesium loss.{{citation needed|date=September 2014}}
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| Severe hypomagnesemia is often treated medically with intravenous or intramuscular [[magnesium sulfate]] solution, which is completely bioavailable, and effective.
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| ===Surgery===
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| ===Prevention===
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| ==References==
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| {{reflist|2}}
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| [[Category:Endocrinology]]
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| {{WH}}
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| {{WS}}
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