Low Serum Magnesium Research Articles

CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance.

CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T>C and c.976G>C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.

Calcium pyrophosphate crystal deposition in a cohort of 57 patients with Gitelman syndrome.

Gitelman syndrome (GS) is the most frequent salt-wasting genetic tubulopathy and a source of hypokalaemia and hypomagnesemia. Chondrocalcinosis (CC) is a frequent feature of GS. The aim of our study was to determine the prevalence, distribution patterns, clinical phenotypes and risk factors for CC in GS. This prospective study of a cohort of 57 patients with GS included a systematic screening for CC by peripheral joint radiography, cervical spine CT and joint US. The prevalence of cervical C1-C2 CC by CT was compared between 33 GS patients and sex- and age-matched controls. Clinical and biochemical features were analysed to identify factors associated with CC. Mean (s.d.) age of patients was 46.5 (12.4) years, 66.7% were women and 93.0% carried SLC12A3 mutations. Mean serum magnesium level was 0.60 (0.30) mmol/l. CC was observed in 79% of patients, with the highest prevalence at the cervical spine (81.8%) followed by the knee (52.6%), wrist (50.9%), ankle (38.6%), TM joint (36.4%), shoulder (33.3%), hip (22.8%), elbow (14.0%) and sclerochoroid (12.1%). Prevalence of CC at the C1-C2 level was higher in the GS cohort than control group (72.7% vs 9.1%) (adjusted odds ratio 21.0, 95% CI 2.8, 156.1, P = 0.003). Independent factors associated with CC were low serum magnesium level and age. GS was associated with widespread CC, favoured by aging and hypomagnesemia. The C1-C2 level was the most affected site. Follow-up of this unique cohort will help understanding the clinical consequences of CC, especially the precise characterization of pyrophosphate arthropathy.

Low Serum Magnesium Level Can be a Risk Factor for Retinopathy in Diabetic Patients: A Cross-Sectional Controlled Study

Low Serum Magnesium Level Can be a Risk Factor for Retinopathy in Diabetic Patients: A Cross-Sectional Controlled Study

Low serum zinc and magnesium–a possible risk factor for first episode Simple febrile seizures in children between 6 months to 5 years of age

Background: Febrile seizure is the most common type of seizure in children. The incidence of febrile seizure is 5-10% in India. There are multiple aetiologies like high grade fever; genetic predisposition, viral infections and trace elements deficiency like iron, zinc, magnesium and calcium are postulated to be risk factors for developing febrile seizures. Recent studies had shown there is a significant association between low serum zinc, low serum magnesium levels and febrile seizures in children.Methods: This was a case control study with 40 children in each group. Children aged 6 months to 5 years with first episode of simple febrile seizures who attends the out-patient department/emergency room (OPD/ER) were included in case group consecutively and 40 children with acute febrile illness without febrile seizures were included in control group. Serum zinc and magnesium levels were estimated for all the children along with other investigations after proper consent from parents. Using statistical package for the social sciences (SPSS) software, independent sample t test was used to analysis the observations between the two groups. Normal lab reference value of serum zinc was 60-120 μg/dl and serum magnesium was 1.7-2.5 mg/dl.Results: The incidence of febrile seizure was high (37.5%) in children between 1-2 years and male (55%) children had increased incidence when compared to female children in case group. The children with febrile seizure had significantly low levels of serum zinc with mean value of 35.08 μg/dl (±8.56) when compared to control group with mean value of 70.23 μg/dl (±13.41) and serum magnesium level in case group was 1.35 mg/dl (±0.29) versus 1.68 mg/dl (±0.42) in control group, which was also statistically significant.Conclusions: The incidence of febrile seizure was high in children between 1-2 years of age with male preponderance. The serum levels of both zinc and magnesium is significantly low in children with febrile seizure pointing a need of further studies in role of supplemental zinc and magnesium in this age group to reduce the incidence of febrile seizures.

Low serum magnesium concentration is associated with the presence of viable hepatocellular carcinoma tissue in cirrhotic patients

This study aimed to ascertain, for the first time, whether serum magnesium (Mg) concentration is affected by the presence of hepatocellular carcinoma (HCC). We retrospectively enrolled consecutive cirrhotic patients with a diagnosis of HCC (n = 130) or without subsequent evidence of HCC during surveillance (n = 161). Serum levels of Mg were significantly (P < 0.001) lower in patients with HCC than in those without (median [interquartile range]: 1.80 [1.62–1.90] mg/dl vs. 1.90 [1.72–2.08] mg/dl). On multivariate logistic regression, low serum Mg was associated with the presence of HCC (OR 0.047, 95% CI 0.015–0.164; P < 0.0001), independently from factors that can influence magnesaemia and HCC development. In a subset of 94 patients with HCC, a linear mixed effects model adjusted for confounders showed that serum Mg at diagnosis of HCC was lower than before diagnosis of the tumor (β = 0.117, 95% CI 0.039–0.194, P = 0.0035) and compared to after locoregional treatment of HCC (β = 0.079, 95% CI 0.010–0.149, P = 0.0259), with two thirds of patients experiencing these changes of serum Mg over time. We hypothesize that most HCCs, like other cancers, may be avid for Mg and behave like a Mg trap, disturbing the body’s Mg balance and resulting in lowering of serum Mg levels.

The Association Between Exposure to Low Magnesium Blood Levels After Renal Transplantation and Cardiovascular Morbidity and Mortality.

Background: Serum magnesium levels are associated with cardiovascular disease and all-cause mortality in the general population and chronic kidney disease patients, but the association between serum magnesium levels and cardiovascular risk after kidney transplantation is not established. We sought to evaluate whether exposure to low serum magnesium levels after renal transplantation is related to cardiovascular morbidity and mortality.Methods: We conducted a single center retrospective study that included all transplanted patients who had a functioning graft for at least 6 months after transplantation between January 2001 and December 2013. We calculated exposure to magnesium using time weighted average for serum magnesium levels, using all values available during the follow-up. Several statistical methods were used, including liner regression analysis, χ2 test, and multivariate Cox proportional hazard model.Results: Four hundred ninety-eight patients were included. Median follow-up was 5.26 years. High time weighted average of serum magnesium was associated with a hazard ratio of 1.94 for all-cause mortality and major cardiovascular outcome compared to low levels (95% CI 1.18–3.19, p = 0.009). The high quartile of time weighted average of serum magnesium was associated with death censored major cardiovascular outcome (hazard ratio 2.13, 95% CI 1.17–3.86, p = 0.013) in multivariate analysis.Conclusions: Exposure to low serum magnesium levels in renal transplant recipients was associated with a lower risk for all-cause mortality and major cardiovascular outcome. These findings contrast the higher risk found in the general population.

Evaluation of Serum Magnesium Level Among Patients with Essential Hypertension in Erbil-Iraq

Background: Hypertension is a well-established risk factor for cardiovascular diseases with an ongoing global increase in incidence. Low Magnesium may play a critical role in cardiovascular physiology. Although many reports have mentioned the correlation between low serum magnesium levels and hypertension, the results were conflicting. Objective: To measure the levels of serum magnesium in hypertensive patients, and to evaluate the prevalence of hypomagnesemia among them. Patients and Methods: A case-control study from June 2019 to December 2019 was carried out in Rizgary Teaching Hospital and Nawroz Health Center involving 100 adult patients with essential hypertension (group I ) and 100 normotensive age and gender-matched controls ( group II). The serum magnesium level was measured in all participants. Results: Females constitute 64 % of both study groups. The means of the age of both study groups show no significant difference (p=0.82). Although the means of Mg level in hypertensive and control groups were within the normal range, it was significantly lower in hypertensive patients (p=0.004). Besides, 4 hypertensive patients (4%) had hypomagnesemia compared with zero in controls (p=0.043). Conclusion: There was a significantly lower mean magnesium level in hypertensives compared to controls. A relationship was assumed between serum magnesium level and hypertension. However; hypomagnesemia was not common in hypertensive patients.

Associations of Serum Magnesium With Insulin Resistance and Testosterone in Women With Polycystic Ovary Syndrome.

ObjectiveThis article aimed to investigate whether serum magnesium is associated with insulin resistance index and testosterone level in women with polycystic ovary syndrome (PCOS).Materials and MethodsOverall 1000 women with PCOS were enrolled in a randomized controlled trial and a cross-sectional analysis of the association of serum magnesium with glucose metabolism markers and testosterone was performed. Serum magnesium, glucose metabolism markers and testosterone were measured. Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR) and quantitative insulin-sensitivity check index (QUICKI). Multivariable linear regression and logistic regression models were used to estimate the association between serum magnesium, insulin resistance and testosterone.ResultsIn comparative analyses, women with higher quartile of serum magnesium had significantly lower fasting glucose, HOMA-IR and testosterone. Multiple linear regression showed serum magnesium was independently negatively associated with insulin, glucose, HOMA-IR, testosterone and positively associated with QUICKI (P for trend <0.05) after adjusting confounding covariates. Logistic regression showed serum magnesium in quartile 1 and 2 were independently associated with insulin resistance status (Quartile 1: OR: 2.15, 95%CI: 1.35-3.40, P = 0.001; Quartile 2: OR: 1.90, 95%CI: 1.20-3.02, P = 0.006), while quartile 1 was marginally associated with hyperandrogenemia status (Quartile 1: OR: 1.45, 95%CI: 0.99-2.11, P = 0.055) after adjusting confounding covariates.ConclusionThe current findings suggest that lower serum magnesium was associated with aggravated insulin resistance and higher testosterone levels among women with PCOS.

Association between serum magnesium levels and abdominal aorta calcification in patients with pre-dialysis chronic kidney disease stage 5.

BackgroundSeveral studies have revealed the relationship between serum magnesium levels and vascular calcification in chronic kidney disease patients. Despite excellent predictability of abdominal aorta calcification for cardiovascular disease events, the relationship between serum magnesium levels and abdominal aorta calcification, as evaluated by quantitative methods, in pre-dialysis patients remains unclear. This study aimed to determine the abdominal aorta calcification volume using computerized tomography and its association with serum magnesium levels in pre-dialysis chronic kidney disease stage 5 patients.MethodsThis single-center cross-sectional study included 100 consecutive patients with pre-dialysis chronic kidney disease stage 5 between January 2016 and May 2020 at Aichi Medical University Hospital, Japan. The relationships between serum magnesium levels and the abdominal aorta calcification volume were assessed using multiple linear regression models after adjusting for clinically relevant factors. We also assessed clinical factors that affect serum magnesium levels.ResultsThe mean serum magnesium level was 2.0 mg/dL (interquartile range, 1.8 to 2.3). Multivariate analyses revealed that a higher serum magnesium level (stand. β = -0.245, p = 0.010) was significantly associated with a reduced abdominal aorta calcification volume, and that a history of cardiovascular disease (stand. β = 0.3792, p < 0.001) and older age (stand. β = 0.278, p = 0.007) were significantly associated with an increased abdominal aorta calcification volume. Moreover, multivariate analysis showed that the use of proton pump inhibitor or potassium-competitive acid blocker was significantly associated with lower serum magnesium levels (stand. β = -0.246, p = 0.019).ConclusionsThe present study revealed that the higher Mg level was significantly associated with lower volume of abdominal aorta calcification in pre-dialysis chronic kidney disease stage 5 patients. Further studies should be undertaken to determine the appropriate magnesium level to suppress vascular calcification.

MO563HIGH DIALYSATE MAGNESIUM AND CORONARY ARTERY CALCIFICATION IN MAINTENANCE HEMODIALYSIS PATIENTS*

Abstract Background and Aims Cardiovascular calcification is highly prevalent among patients with end-stage renal disease (ESRD). Low normal serum magnesium has been linked to a more severe degree of vascular calcification and a decrease in patient survival. An inhibitory effect of extracellular magnesium on osteogenic transformation of vascular smooth muscle cells and the upregulation of anti-calcification protein have been confirmed in vitro. Increased dialysate magnesium concentration has also been shown to lower calcification propensity of the serum of maintenance hemodialysis (HD) patients. Method This study is an investigator initiated, single-blinded, parallel-group, matched case-control clinical trial that investigated the effect of high dialysate magnesium concentration for 24 weeks on the progression of coronary artery calcification (CAC) in maintenance HD patients. The changes in laboratory data and bone mineral density (BMD) were also examined. Seventy-six ESRD patients underwent CAC screening by multi-slice computed tomography and BMD measurement by dual-x-ray absorptiometry. Only patients with Agatston score&amp;gt;300 were included. They were matched according to the initial CAC score that fell within 20% of one another. Twenty patients were assigned to high dialysate magnesium concentration of 1.75 mEq/L and the matched controls were kept on standard dialysate magnesium concentration of 0.7 mEq/L. CAC and BMD measurements were repeated after 24 weeks. Laboratory data were obtained prior to dialysis at study entry, 8-week intervals during the study and 2 weeks after the study ended. Results There were no significant differences in age, sex, BMI, underlying diseases, dialysis vintage, medications, baseline CAC scores and BMD. The median baseline CAC Agatston score (Volume score) were 1923 (720) and 1672 (785) in the standard and high dialysate groups, respectively. At the end of the study, a significant increase in the CAC score was observed in both groups. Because majority of the included patients had severe calcification burden at baseline, patients were categorized into 2 subgroups using the median baseline CAC Agatston (1600) and Volume scores (700) as cut-offs. Among patients with CAC Agatston score &amp;lt;=1600, CAC score increased significantly in the standard dialysate magnesium group (P&amp;lt;0.01) but was stable in the high dialysate magnesium group (P=0.33). Among patients with CAC Agatston score &amp;gt;1600, the severity of CAC worsened in both groups. The progression of CAC was analyzed by the difference between the follow-up and the baseline square root transformed Agatston and Volume scores. In subgroup of patients with less severe calcification, more patients in the standard dialysate magnesium group progressed compared to the high dialysate magnesium group (P=0.03). In subgroup of patients with more severe calcification, the number of progressors were comparable among the 2 groups. Serum and ionized magnesium levels increased substantially during the study and returned to baseline after the return to standard dialysate magnesium concentration. The highest predialysis serum magnesium was 3.8 mg/dL. Most patients who received high dialysate magnesium reported the disappearance of symptoms of muscle cramps (P=0.01) and requested the high dialysate magnesium be continued after the end of the study. There were no significant changes in serum calcium, phosphate or PTH levels. The decline in BMD was observed in both groups but the difference did not reach statistical significance. Conclusion High dialysate magnesium was well tolerated and could ameliorate the progression of CAC in maintenance HD patients with mild to moderate vascular calcification.

The relation between acute changes in the systemic inflammatory response and circulating thiamine and magnesium concentrations after elective knee arthroplasty

Thiamine diphosphate (TDP) and magnesium are co-factors for key enzymes in human intermediary metabolism. However, their role in the systemic inflammatory response (SIR) is not clear. Therefore, the aim of the present study was to examine the relation between acute changes in the SIR and thiamine and magnesium dependent enzyme activity in patients undergoing elective knee arthroplasty (a standard reproducible surgical injury in apparently healthy individuals). Patients (n = 35) who underwent elective total knee arthroplasty had venous blood samples collected pre- and post-operatively for 3 days, for measurement of whole blood TDP, serum and erythrocyte magnesium, erythrocyte transketolase activity (ETKA), lactate dehydrogenase (LDH), glucose and lactate concentrations. Pre-operatively, TDP concentrations, erythrocyte magnesium concentrations, ETKA and plasma glucose were within normal limits for all patients. In contrast, 5 patients (14%) had low serum magnesium concentrations (< 0.75 mmol/L). On post-operative day1, both TDP concentrations (p < 0.001) and basal ETKA (p < 0.05) increased and serum magnesium concentrations decreased (p < 0.001). Erythrocyte magnesium concentrations correlated with serum magnesium concentrations (rs = 0.338, p < 0.05) and remained constant during SIR. Post-operatively 14 patients (40%) had low serum magnesium concentrations. On day1 serum magnesium concentrations were directly associated with LDH (p < 0.05), WCC (p < 0.05) and neutrophils (p < 0.01). Whole blood TDP and basal ETKA increased while serum magnesium concentrations decreased, indicating increased requirement for thiamine and magnesium dependent enzyme activity during SIR. Therefore, thiamine and magnesium represent potentially modifiable therapeutic targets that may modulate the host inflammatory response. Erythrocyte magnesium concentrations are likely to be reliable measures of status, whereas serum magnesium concentrations and whole blood TDP may not.ClinicalTrials.gov: NCT03554668.

Abstract P017: Sex Differences Of Longitudinal Changes Of Cognitive Function Over 9 Years Among Older Adults: Findings From Tanushimaru Cohort Study

Introduction: Mild cognitive impairment (MCI) is often a precursor to dementia and is therefore of increasing interest. Some previous studies showed MCI progresses to dementia faster in women than in men. However, sex differences in the progression of cognitive decline requires additional study. Hypothesis: Correlates of changing patterns of cognitive function differ between the sexes. Methods: We recruited 2653 participants (mean age: 59.2±12.0 years, male 41.6%) as a population-based sample of Tanushimaru, Japan in 2009 and conducted a longitudinal study with a follow-up examination in 2018. Mini-Mental State Examination (MMSE) was a 30-point test used to assess cognitive function. We classified cognitive function as dementia, MCI and normal using MMSE cutpoints ≤23, 24-27, and ≥28, respectively. We performed analysis of covariance (ANCOVA) to examine the correlates of change in MMSE scores in 973 people who attended in both 2009 and 2018. Results: Mean MMSE scores in 2009 were 27.7±2.5 (men:27.4±2.8, women:27.8±2.3, p=0.0016) and in 2018 were 28.3±2.3 (men:28.3±2.2, women:28.4±2.5). Changes in MMSE scores were 0.47±3.04 in men and 0.26±3.13 in women. Cognition status progressed from normal to MCI or from MCI to dementia over 9 years in 26.3% (men:24.9%, women:27.2%) and 2.6%(men:2.8%, women:2.5%), respectively. On the other hand, 72.0% of MCI (men:69.7%, women:73.4%) reverted to normal cognitive status. Cognitive improvement for 9 years was associated with higher high-density lipoprotein (HDL) cholesterol, lower log-transformed serum insulin in 2009 in men(p=0.0198, p=0.008),and higher estimated glomerular filtration rate (eGFR) in 2009 in women (p=0.058). Lower serum magnesium levels in 2009 were marginally associated with the progression from MCI to dementia in both sexes. (Figure 1). Conclusions: Cognitive status function was better in women and improved in both sexes during 9 years. A sex-stratified approach for describing correlates of cognitive status may be useful.

A Higher Serum Calcium Level is an Independent Risk Factor for Vision-Threatening Diabetic Retinopathy in Patients with Type 2 Diabetes: Cross-Sectional and Longitudinal Analyses

ObjectiveAn elevated serum calcium level is associated with a higher risk of type 2 diabetes (T2D), but its role in microvascular complications remains unclear. This study was conducted to investigate the association between serum calcium levels and vision-threatening diabetic retinopathy (VTDR). MethodsThis study employed a cross-sectional and longitudinal design. The cross-sectional part included all patients treated for T2D at Shanghai General Hospital between 2007 and 2016, while the longitudinal part involved an overlapping cohort of diabetic patients without VTDR who were followed from their admission until December 2019. Multivariable logistic and Cox proportional hazard regression analyses were performed, respectively. VTDR was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, or clinically significant macular edema. ResultsA total of 3269 patients were included in the cross-sectional analysis, and 649 patients were included in the longitudinal analysis. In the cross-sectional analysis, higher corrected serum calcium (odds ratio: 1.31 per 0.1 mmol/L, 95% confidence interval: 1.16-1.49), younger age, longer diabetes duration, albuminuria, impaired renal function, and lower serum magnesium were independently associated with VTDR. In the longitudinal analysis, 95 subjects developed VTDR during follow-up (9.7 years, interquartile range: 7.4-10.9 years). Higher corrected serum calcium (hazard ratio: 1.38 per 0.1 mmol/L, 95% confidence interval: 1.10-1.72), younger age, longer diabetes duration, sub-VTDR, albuminuria, lower serum magnesium, and higher glycated hemoglobin were identified as independent risk factors for VTDR. ConclusionsA higher serum calcium level may be an independent risk factor for VTDR in patients with T2D.

Magnesium Disorders and Prognosis in Heart Failure: A Systematic Review.

Magnesium is an essential mineral for the human body and plays an important role in cardiovascular health. Hypomagnesaemia has been linked with increased cardiovascular mortality in heart failure; however, previous studies have yielded conflicting results. Even fewer studies have addressed the association between hypermagnesemia and prognosis in heart failure. The aim of the present systematic review was to investigate the association of serum magnesium levels with cardiovascular and all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). Cardiovascular morbidity, referring to heart failure rehospitalizations and ventricular arrhythmias, was also investigated. Eligible studies were identified by searching PubMed and Scopus. The Quality in Prognosis (QUIPS) tool was used to assess the quality of included studies. Eight studies (total of 13,539 patients with HFrEF) that assessed the effects of serum magnesium levels on cardiovascular mortality, all-cause mortality, and cardiovascular morbidity met inclusion criteria. In half of the studies, hypomagnesemia was found to be an independent risk factor for cardiovascular mortality, including sudden cardiac death. Only 1 study reported that hypermagnesemia (serum magnesium levels above 2.4 mg/dL) is a prognostic factor for noncardiac mortality suggesting that hypermagnesemia is more likely an indicator of comorbidities rather than a true independent prognostic marker. Finally, low serum magnesium levels were not associated with readmissions for heart failure or ventricular arrhythmias in patients with HFrEF.

Serum magnesium: time for a standardized and evidence-based reference range.

Magnesium deficiency can have serious health consequences. Low magnesium intake or low serum levels are risk factors for e.g. type 2 diabetes and cardiovascular diseases. Despite its scientifically recognized importance, too little attention is paid to magnesium in clinical practice. This may be due to the fact that there is no uniform and evidence-based reference range for serum magnesium as is the case for other electrolytes such as sodium and potassium. The serum magnesium concentration is also of a limited informative value, as it is maintained for a long time by releasing magnesium from body pools. A low serum magnesium is a definite sign of magnesium deficiency; however, values within the reference range do not rule out deficiencies. Nevertheless, serum magnesium should become part of routine diagnostics in order to be able to better detect deficiency states. For serum magnesium, a reference range of 0.75 to 0.95 mmol/L (1.82 to 2.31 mg/dL) can often be found. However, according to the current data situation, serum magnesium values of less than 0.85 mmol/L are associated with increased health risks. Therefore, the lower limit of the reference range should be raised to 0.85 mmol/L (2.07 mg/dL).

RELATIONSHIP BETWEEN SERUM MAGNESIUM AND ERYTHROPOIETIN RESPONSIVENESS IN HEMODIALYSIS PATIENTS

Background: Serum magnesium is associated with anemia. But the roles of magnesium in anemia and erythropoietin (EPO) responsiveness remain not well knwon in maintenance hemodialysis (MHD) patients. Objective: to study the level of serum magnesium and its relationship with EPO responsiveness in MHD patients. Patients and methods: This study was done in hemodialysis unit at Bab El-Shaareya University Hospital, during the period of January 2020 to June 2020. A total of 60 regular hemodialysis (RHD) patients were recruited for this survey. Their anthropometrics and laboratory data were collected. EPO responsiveness was evaluated by the erythropoietin resistance index (ERI). The patients were divided into 2 groups according to EPO resistance Index (ERI) Group A, the patients with higher ERI than 1.52, and group B with lower ERI than 1.52. Multivariate logistic regressions were conducted to evaluate the factors that may be associated with EPO responsiveness. Results: The mean serum magnesium level was higher than normal levels in RHD patients, while nearly no hypomagnesemia was observed. A multivariate logistic regression model revealed that lower serum magnesium levels were correlated with a high ERI. The OR of a high ERI was found to be 2.89 (93% CI 1.197–4.715, p = 0.005) for group A and 1.57 (94% CI 0.779––2.941, p > 0.05) for group. Conclusion: Serum magnesium levels were found to be higher than normal levels in RHD patients. A high serum magnesium level was shown to be correlated with good EPO responsiveness and it has a protective role from EPO hyporesponsiveness.

Correlation of serum magnesium levels in febrile convulsions in children: a cross sectional comparative study

Background: Febrile convulsions is one of the most common type of seizures seen in children. It has been suggested that low serum magnesium (Mg) has occasionally been associated with epilepsy. A positive correlation of the hypomagnesemia with the severity of epilepsy was also found. The present study aimed to estimate the levels of serum magnesium in children with febrile convulsions and to compare serum magnesium levels with normal children.Methods: Fifty patients who were eligible after screening for inclusion and exclusion criteria were included in the study group after a signed written informed consent and 50 controls were also taken. A detailed history, clinical examination and these investigations were done – complete blood count (CBC) (Hb, DC and ESR), serum calcium, serum magnesium, serum electrolytes, random blood sugar and cerebrospinal fluid (CSF) analysis.Results: The serum magnesium level was normal in 45 patients (90%) with febrile convulsions, low levels in 4 cases (8%) and high levels seen in 1 case (2%). Serum magnesium levels were normal in all 50 controls. In this study, the serum magnesium levels has got no correlation in patients with febrile convulsion. So, routine magnesium supplementation need not be prescribed in normal subjects to prevent febrile convulsions.Conclusions: Routine measurement of serum levels of Mg, glucose and calcium are warranted in subject with febrile convulsions. However, large prospective studies are further required in future to establish the correlation of serum Mg and febrile convulsions so that a standard guidelines can be set up which could be followed universally.

Role of serum magnesium in acute exacerbations of chronic obstructive pulmonary disease

Background: This prospective study was done to assess the association between serum magnesium deficiency and its effect on exacerbation of chronic pulmonary obstructive disease (COPD), and also to probably suggest a cut-off level which may be useful for predicting clinical outcomes and serving as a target value for therapeutic intervention. Methods: This study was conducted among 100 patients in a tertiary hospital, who were diagnosed with COPD, and their serum magnesium levels were measured when they presented to the hospital during routine check-up (stable) and during an exacerbation. Their PEFR and oxygen saturation were also measured to assess severity. Results: Out of 100 patients studied, 91 were males and 9 were females, of which 38 of them were aged 60 or below and 62 of them aged 61 and above. The average serum magnesium levels of patients presenting during routine check-up was 2.08 mg/dl (below 60) and 2.06 mg/dl (above 61) as compared to values during an exacerbation which was 1.58 mg/dl (below 60) and 1.60 mg/dl (above 60) which was significant. Our study also determined a serum magnesium cut-off value averaging 1.65 mg/dl, which may be useful therapeutic target for intervention.Conclusions: Serum low serum magnesium levels has a definite association with exacerbations of COPD. Earlier therapeutic interventions may help in decreasing the episodes of exacerbation. A significant reduction of magnesium levels may correlate with severity of airway obstruction.

Renal function, serum magnesium levels and mortality in COVID-19 patients with type 2 diabetes.

Patients with type 2 diabetes (T2D) and Latin American subjects in particular are at an increased risk of developing severe COVID-19 and mortality. Altered renal function and lower magnesium levels have been reported to play important roles in the pathophysiology of T2D. The aim of the study was to investigate the relationship between renal function, serum magnesium levels and mortality in T2D patients with COVID-19. In this retrospective study, we characterized 118 T2D and non-diabetic subjects hospitalized with COVID-19. Patients were clinically characterized and electrolyte, renal function and inflammatory markers were evaluated. Patients were grouped according to their estimated glomerular filtration rate (eGFR <60 mL/min per 1.73 m2). T2D patients had lower eGFR and serum magnesium levels when compared to non-diabetics (59.7 ± 32.8 vs. 78.4 ± 33.8 mL/min per 1.73 m2, P = 0.008 and 1.9 ± 0.3 vs. 2.1 ± 0.3 mEq/L, P = 0.012). Survival was worse in T2D patients with eGFR levels less than 60 mL/min per 1.73 m2 as estimated by Kaplan-Meier analyses (log-rank test <0.0001). The Cox model for T2D patients showed that eGFR (HR 0.970, 95% CI 0.949 to 0.991, P = 0.005) and magnesium (HR 8.025, 95% CI 1.226 to 52.512, P = 0.030) were associated with significantly increased risk of death. Reduced eGFR and magnesium levels were associated with increased mortality in our population. These results suggest that early assessment of kidney function, including magnesium levels, may assist in developing effective treatment strategies to reduce morbidity and mortality among Latin American COVID-19 patients with T2D.

Serum magnesium and visfatin levels in newly diagnosed non-obese type 2 diabetes without insulin resistance: a cross-sectional study

Background. Previous studies demonstrated that type 2 diabetes (T2D) patients have low serum magnesium and high serum levels of visfatin. This study aimed to show the relationship between serum levels of insulin, visfatin, and magnesium in T2D patients characterized by a non-insulin resistance status. Methods. This was a cross-sectional study conducted in the Hawler Medical University, Kurdistan Region, Iraq from April 2019 to March 2020. A total number of 130 T2D patients and 45 healthy subjects were enrolled in the study. T2D patients with scores of homeostasis model assessment — insulin resistance (HOMA-IR) of < 2.5 were included. Serum levels of magnesium, visfatin, and glycemic indices, including fasting serum glucose, insulin, visfatin, and glycated hemoglobin were determined. Results. The serum level of visfatin is significantly higher in T2D patients than the corresponding values of the healthy subjects. Serum magnesium level is significantly correlated with the percentage of the glycated hemoglobin (Spearman’s correlation factor = 0.184, P = 0.036), and a positive significant correlation between serum insulin and visfatin (r = 0.216, P = 0.014) was observed. Multivariate regression analysis of the association of fasting serum insulin as a dependent variable with serum magnesium and visfatin as independent variables showed a non-significant positive correlation (r = 0.197, P = 0.082). Conclusion. Significant low serum levels of magnesium and visfatin are observed in non-insulin resistant T2D patients with a HOMA-IR score of < 2.5. Serum visfatin and magnesium levels showed significant correlations with glycemic indices.