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Magnesium Deficiency

Deficiencies Magnesium

Magnesium deficiency or hypomagnesemia is an electrolyte imbalance characterized by serum magnesium levels below 1.5-2.5 mEq/L. Magnesium is essentially important in the maintenance of the cardiovascular and the nervous system. Magnesium is normally excreted through the kidneys and any abnormalities in the kidneys that lead to the increased excretion of magnesium will consequently result in magnesium deficiency.


Presentation

The following symptoms and signs are closely associated with magnesium deficiency among patients:

Dysphagia
  • Hypomagnesemia on admission seemed to arise from long-lasting poor food intake and malnutrition, because it improved after the disappearance of dysphagia with a goiter resection.[ncbi.nlm.nih.gov]
  • Our index patient had striking neurological manifestations including generalized tremulousness, grimaces and fibrillary twitches of facial muscles, athetoid and choreiform movements of upper extremities, dysphagia, inability to speak, repeated convulsions[ncbi.nlm.nih.gov]
  • […] totally non-specific symptoms and signs ascribable to the primary disease; neuromuscular hyperactivity including tremor, myoclonic jerks, convulsions, Chvostek sign, Trousseau sign (rarely), spontaneous carpopedal spasm (rarely), ataxia, nystagmus and dysphagia[ncbi.nlm.nih.gov]
  • Dysphagia and vertical nystagmus in magnesium deficiency . Ann Intern Med 1978 ; 89: 222 – 3 . Google Scholar Crossref Medline ISI 18. Iseri, LT, Fairshter, RD, Hardemann, JL, Brodsky, MA.[doi.org]
  • Dysphagia and vertical nystagmus in magnesium deficiency. Ann Intern Med 1978 ; 89: 222 – 3. Google Scholar Crossref Medline ISI 18. Iseri, LT, Fairshter, RD, Hardemann, JL, Brodsky, MA.[dx.doi.org]
Chronic Watery Diarrhea
  • The gastrointestinal causes include the following: protein-calorie malnutrition, the intravenous administration of Mg-free fluids and total parenteral nutrition, chronic watery diarrhea and steatorrhea, short bowel syndrome, bowel fistula, continuous[ncbi.nlm.nih.gov]
Jaundice
  • In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration.[ncbi.nlm.nih.gov]
Hepatomegaly
  • In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration.[ncbi.nlm.nih.gov]
Muscle Twitch
  • Symptoms of Magnesium Deficiency Signs & Symptoms of Magnesium Deficiency: Poor immune function Bone Loss Muscle pain and muscle twitching Depression High Blood Pressure Increase cholesterol Hypoglycemia or other blood sugar problems Fatigue Thyroid Disease[towncenterwellness.com]
  • Signs & Symptoms of Magnesium Deficiency: Poor immune function Bone Loss Muscle pain and muscle twitching Depression High Blood Pressure Increase cholesterol Hypoglycemia or other blood sugar problems Fatigue Thyroid Disease Magnesium has been shown to[glutenfreesociety.org]
  • Keep in mind that involuntary muscle twitches may have many other causes. For example, they may be caused by stress or too much caffeine.[healthline.com]
  • Muscle twitches and cramps Although involuntary muscle twitches may have many other causes, such as stress, these twitches and muscle cramps can be signs of magnesium deficiency. Some deficiencies may even cause seizures.[longevitylive.com]
  • Your muscles are sore and twitchy As most magnesium is stored in the tissue, leg cramps, foot pain, or muscle twitches can be one of the early signs of a magnesium deficiency, especially if they happen at night. 2.[cosmopolitan.co.uk]
Vertebral Fractures
  • Here we report a case of an 82-year-old woman with a giant adenomatous goiter and severe osteoporosis with multiple vertebral fractures, whose clinical course indicated that her osteoporosis was probably due to Mg deficiency.[ncbi.nlm.nih.gov]
Coprolalia
  • These comorbid conditions and symptomatology include allergy, asthma, autism, attention deficit hyperactivity disorder, obsessive compulsive disorder, coprolalia, copropraxia, anxiety, depression, restless leg syndrome, migraine, self-injurious behavior[ncbi.nlm.nih.gov]

Workup

The following diagnostic modalities and tests are available for the workup of patients suspected with magnesium deficiency:

  • Electrocardiography (ECG): Low serum magnesium will result in prolonged conduction and ST wave depression on the ECG tracings.
  • Magnesium blood levels: This blood test determines the actual serum concentration. The results derived from this test must be correlated with magnesium excretory results because magnesium is biologically active within the intracellular portion of the cell.
  • Calcium serum levels: This blood test shows the concentration of calcium in the body because calcium concentration is directly affected by magnesium levels especially in the metabolism of vitamin D in the system.
  • Potassium blood levels: The blood levels of potassium decrease with hypomagnesemia. Low serum potassium levels also incites some characteristic ECG changes.
  • Phosphate levels: The diminished adenosine triphosphate (ATP) levels seen in hypomagnesemia will consequently result in low serum levels of phosphates during the blood tests.
Myocardial Fibrosis
  • fibrosis which, in turn, would cause myocardial damage and replacement fibrosis.[ncbi.nlm.nih.gov]
  • Inadequate dietary magnesium intake increases atherosclerotic plaque development in rabbits 113 and induces myocardial fibrosis similar to what is found in human cardiomyopathy endomyocardial fibrosis. 114 A diet deficient in magnesium in the Cebus monkey[dx.doi.org]
Liver Biopsy
  • Subsequent computerized tomographic scan and liver biopsy showed the presence of severe fatty liver.[ncbi.nlm.nih.gov]

Treatment

In patients presenting with hypomagnesemia and hypocalcemic signs with concurrent arrhythmia, an intravenous drip of magnesium sulfate of up to 50 milliequivalents in a period of 8 to 24 hours, repeated in 3 to 5 days, can correct the symptoms of the deficiency. Oral doses of magnesium chloride and magnesium lactate may be given as maintenance doses to correct magnesium deficiency among patients.

Calcium supplementations and potassium supplementations can also be given to patients suffering from magnesium deficiency with concurrent hypocalcemia and hypomagnesemia to allay the untoward effects brought about by the electrolyte imbalance [8]. Patients suffering from renal insufficiency with high renal creatinine clearance can only be given intravenous magnesium sulfate in up to 25% to 50% of the normal dose to prevent inadvertent hypermagnesemia [9]. Patients with mild magnesium deficiency can benefit from eating green leafy vegetables, rice grains, and legumes which are naturally rich in elemental magnesium [10].

Prognosis

Magnesium deficiency has a good prognosis in general, especially when diagnosed and treated promptly. Morbidity and mortality incidences associated with hypomagnesemia correlate closely with it comorbid events like heart failure, pregnancy induced hypertension (PIH), and diabetes. The mild untoward signs and symptoms seen in magnesium deficiency are easily correctable by the supplementary replacement of the element in the diet.

Etiology

The following medical conditions can result in significant magnesium deficiency:

Epidemiology

In the United States, people suffering from magnesium deficiency number to about 2% of the population. Studies have inferred that more than three fourths of Americans could not meet the recommended daily allowance of dietary magnesium [3]. More than 60% of alcoholics are likely to suffer from magnesium deficiency. A fourth of the patients who are diagnosed with diabetes have a concurrent hypomagnesemia. Cohort studies have demonstrated that neonates have a higher demand for intracellular magnesium, and are more likely to suffer from magnesium deficiency than their older counterparts.

Sex distribution
Age distribution

Pathophysiology

Magnesium deficiency is already recognized as a significant etiologic factor in the propagation of cardiac arrhythmias [4]. Imbalances in magnesium concentration directly affect cardiac electrical activities, myocardial contractility, and general vascular tone. A significant drop in magnesium levels has been demonstrated to prolong conduction with a slight ST wave depression. Even patients presenting with mild hypomagnesemia can result in dire consequences especially among cardiac patients with established congestive heart failure and myocardial ischemia [5]. A progressive decrease in intracellular magnesium can increase vascular tone and resistance causing hypertension in most patients.

Magnesium has been found to stabilize the threshold potential of axons in neuromuscular systems. Any significant decrease in magnesium brings the neural cells into a hyperexcitable state causing tetany, hyperreflexia, muscle crampings, and seizures. The decreasing intracellular magnesium concentration diminishes the estrogen release thereby, worsens the osteoporotic process among post-menopausal women [6]. One of the main function of magnesium is to increase the cell’s sensitivity to insulin, thus, hypomagnesemia is usually a comorbid event among diabetics.

Prevention

High risk patients should have a healthy balance of diet rich in magnesium like sunflower seeds, almonds, cashew, soy products, avocados, and brown rice to prevent magnesium deficiency. High risk patients, especially diabetic, should control alcohol intake to prevent progressive loss of magnesium. Patients on magnesium wasting diuretics suffering from hypomagnesemia should have their maintenance medications revised to prevent further magnesium loss in the urine.

Summary

Magnesium deficiency is also defined as serum magnesium falling below 0.70 mmol/L caused by inadequate magnesium intake or impaired renal excretion of the element. Magnesium deficiency states often coexists with hypokalemia and hypocalcemia presenting as lethargy, arrhythmias, seizures, tetany, and tremors. Magnesium deficiency is easily corrected with magnesium replacement.

Patient Information

Definition: Magnesium deficiency or hypomagnesemia is an electrolyte imbalance characterized by magnesium levels below 1.5-2.5 mEq/L causing significant effects in the neuromuscular system and the cardiovascular system of affected patients.

Cause: Magnesium deficiency can be caused by low dietary intake of magnesium and kidney problems that lead to excessive magnesium wastage. Patients with irritable bowel diseases, patients with nephrotoxic drugs, and pregnant women can also be prone to magnesium deficiency.

Symptoms: Patients with low magnesium levels can present with muscle cramps, cardiac arrhythmias, headaches, irritability, premenstrual syndrome, and sleep cycle changes.

Diagnosis: The diagnostic workup for patients with magnesium deficiency includes magnesium serum and excretory levels, blood tests for phosphate, calcium, and potassium levels, and ECG.

Treatment and follow-up: Intravenous replacement with magnesium sulfate for symptomatic patients with hypocalcemia, oral magnesium chloride and magnesium lactate for milder cases, and dietary supplementations of exogenous magnesium are the main treatment options.

References

Article

  1. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia. Requested vs routine. JAMA. Jun 13 1990; 263(22):3063-4.
  2. Konrad M, Weber S. Recent advances in molecular genetics of hereditary magnesium-losing disorders. J Am Soc Nephrol. Jan 2003; 14(1):249-60.
  3. Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. Am Fam Physician. Jul 15 2009; 80(2):157-62.
  4. Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham Heart Study. Circulation. Jan 1 2013; 127(1):33-8.
  5. Kelepouris E, Agus ZS. Hypomagnesemia: renal magnesium handling. Semin Nephrol. Jan 1998; 18(1):58-73.
  6. Rude RK, Gruber HE. Magnesium deficiency and osteoporosis: animal and human observations. J Nutr Biochem. Dec 2004; 15(12):710-6.
  7. Drueke TB, Lacour B. Magnesium homeostasis and disorders of magnesium metabolism. In: Feehally J, Floege J, Johnson RJ, eds. Comprehensive Clinical Nephrology. 3rd ed. Philadelphia, PA: Mosby; 2007:136-8.
  8. Navarro J, Oster JR, Gkonos PJ, Ruiz JP, Rhamy RK, Perez GO. Tetany induced on separate occasions by administration of potassium and magnesium in a patient with hungry-bone syndrome. Miner Electrolyte Metab. 1991; 17(5):340-4.
  9. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. Aug 15 2005; 62(16):1663-82.
  10. Naderi AS, Reilly RF Jr. Hereditary etiologies of hypomagnesemia. Nat Clin Pract Nephrol. Feb 2008; 4(2):80-9.

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Last updated: 2019-06-28 11:05