Magnesium deficiency

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Overview

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.[1] It is generally corrected by an increase of magnesium in diet, oral supplements, and in severe cases, intravenous supplementation.

Historical Perspective

Magnesium deficiency in humans was first described in the medical literature in 1934.[2]

Classification

Pathophysiology

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.[3] Low magnesium intake over time can increase the risk of illnesses, including high blood pressure and heart disease, diabetes mellitus type 2, osteoporosis, and migraines.[3]

Causes

Causes of magnesium deficiency include diet, alcohol abuse, chronic stress, poorly controlled diabetes, excessive or chronic vomiting and/or diarrhea. Phytate[4] or oxalate[5] 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 diuretics, cisplatin, ciclosporin, amphetamines, and possibly proton pump inhibitors.[6] Also deficiency may occur in Bartter syndrome[7] and Gitelman syndrome.[8]

Differentiating Magnesium deficiency from Other Diseases

Epidemiology and Demographics

57% of the US population does not meet the US RDA for dietary intake of magnesium.[9] 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 inhibitors[6] or chronic alcoholism.[3]

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Symptoms of magnesium deficiency include hyperexcitability, muscular symptoms (cramps, tremor, fasciculations, spasms, tetany, weakness), fatigue, 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, rapid heartbeat, continued muscle contractions, nausea, vomiting, personality changes, delirium, hallucinations, low calcium levels, low serum potassium levels, retention of sodium, low circulating levels of parathyroid hormone (PTH),[10] and potentially death from heart failure.[11] 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.[12][13]

Physical Examination

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%.

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

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.

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 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.Template:Citation needed Severe hypomagnesemia is often treated medically with intravenous or intramuscular magnesium sulfate solution, which is completely bioavailable, and effective.

Surgery

Prevention

References

  1. "Definition of Magnesium Deficiency". MedicineNet.com. Retrieved 31 May 2014. 
  2. Hirschfelder, A. D.; Haury, V. G. (1934). "Clinical Manifestations of High and Low Plasma Magnesium; Dangers of Epsom Salt Purgation in Nephritis". Journal of the American Medical Association. 102: 1138. doi:10.1001/jama.1934.02750140024010. 
  3. 3.0 3.1 3.2 "Magnesium: Fact Sheet for Health Professionals". nih.gov. National Institutes of Health. Retrieved 8 November 2014. 
  4. Forbes, RM; Parker, HM; Erdman JW, Jr (Aug 1984). "Effects of dietary phytate, calcium and magnesium levels on zinc bioavailability to rats." (PDF). The Journal of Nutrition. 114 (8): 1421–5. PMID 6747725. 
  5. Oxalates may absorb magnesium, background information indicating possibility of oxalates absorbing magnesium.
  6. 6.0 6.1 "FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)". fda.gov. F.D.A. U.S. Food and Drug Administration. Retrieved 8 November 2014. 
  7. Rodríguez-Soriano, Juan (May 1998). "Bartter and related syndromes: the puzzle is almost solved". Pediatric Nephrology. 12 (4): 315–327. PMID 9655365. doi:10.1007/s004670050461. Retrieved 8 November 2014. 
  8. Simon, DB; Nelson-Williams, C; et al. (January 1996). "Gitelman's variant of Bartter's syndrome, inherited hypokalaemic alkalosis, is caused by mutations in the thiazide-sensitive Na-Cl cotransporter". Nat Genet. 12 (1): 24–30. PMID 8528245. doi:10.1038/ng0196-24. Retrieved 8 November 2014. 
  9. "Nutrient Intakes Percent of population 2 years old and over with adequate intakes based on average requirement". Community Nutrition Mapping Project. 2009-07-29. Retrieved 2012-02-11. 
  10. 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
  11. Blaylock, Russell L. (2006). Health and nutrition secrets that can save your life. Albuquerque, NM: Health Press. p. 395. ISBN 978-0-929173-48-1. 
  12. Kobrin, SM; Goldfarb, S (Nov 1990). "Magnesium deficiency.". Seminars in nephrology. 10 (6): 525–35. PMID 2255809. 
  13. MedlinePlus Encyclopedia Magnesium in diet

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