Normal Serum Magnesium Levels Research Articles

A cross sectional study on prevalence of hypomagnesemia and hypokalemia in patients with STEMI and its relationship with occurrence of arrhythmias

Background: Cardiovascular disease is one of the leading causes of mortality, morbidity, and increased health-care cost. Magnesium and potassium has been implicated in the pathogenesis of acute myocardial infarction (AMI) and its complications. Magnesium ions and potassium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium and potassium concentration was found to have great significance in AMI. The present study was undertaken to evaluate the prognostic value of serum magnesium and potassium in AMI. Aim: This study aimed to assess the dynamic changes in serum magnesium and potassium levels in acute STEMI patients and evaluate whether these levels correlate with presence of arrhythmias. Materials and methods: A comprehensive analysis was conducted over 18 months on 100 patients with acute STEMI. ECG examination was done and blood sample was taken for evaluation of serum magnesium and serum potassium. Statistical analysis was performed to examine correlation with MI and arrhythmias. Results: In the present study 51-60 years of age were maximum, males were most commonly seen. Mean ±SD of serum magnesium in VPC was 1.900±.3232, sinus tachycardia was 1.850±.1195, maximum in RBBB was 2.200±.000 followed by RBBB/CHB was 2±0, and minimum in 1.288±.5621. Results were found to be significant when comparing type of arrhythmia with serum magnesium. Mean ±SD of serum potassium in VPC was 3.030±.9627, sinus tachycardia was 3.638±.4502, maximum in RBBB was 4.600±.000 and minimum VT/RBBB in 2.850±1.0344. Results were found to be significant. Conclusion: Patients of AMI with low serum magnesium and potassium levels are found to be more prone to develop arrhythmias as compared to those with normal serum magnesium and potassium levels. Hence, it can be concluded that measurement of serum magnesium and potassium level is of prognostic significance in AMI.

8317 Biochemical Adequacy And Renal Complications In Long-Term Management Of Patients With Postsurgical Hypoparathyroidism

Abstract Disclosure: A. Hong: None. J. Park: None. W. Choi: None. J. Yoon: None. H. Kim: None. H. Kang: None. Background: Hypoparathyroidism (HypoPT) most commonly develops after neck surgery, particularly thyroid surgery. Permanent postsurgical HypoPT necessitates calcium and active vitamin D supplementation for 12 months or more due to irreversible parathyroid damage following surgery. This study investigated the biochemical adequacy of conventional therapy (i.e., active vitamin D and/or calcium) in patients with permanent postsurgical HypoPT based on recent guidelines and assessed the incidence of renal complications. Materials and Methods: The study included 62 adult patients with permanent postsurgical HypoPT who underwent total thyroidectomy for papillary thyroid cancer at Chonnam National University Hwasun Hospital. Biochemical parameters, including albumin-adjusted serum total calcium, ionized calcium, phosphate, creatinine, parathyroid hormone, magnesium, 25-hydroxyvitamin D (25[OH]D), and 24-h urine calcium, were measured. Renal ultrasound and KUB X-ray were performed for all patients. Results: The mean age of the patients was 55.5 ± 12.4 years, with 48 (77.4%) being female. The median follow-up duration after surgery was 10.6 years (interquartile range 9.0-15.5 years). At the time of evaluation, all patients were treated with calcitriol. Additional treatment, including calcium carbonate or cholecalciferol, was received by 43 (69.4%), and 28 (45.2%) were given thiazide diuretics. Thirty-seven (59.7%) patients had values below the recommended serum calcium (albumin-adjusted or ionized) concentration, while three (4.8%) had values above the upper normal limit of serum phosphate level. Serum 25(OH)D levels were maintained within the normal range (30-50 ng/mL) in 27 (43.5%) patients, and 47 (75.8%) patients met normal serum magnesium levels. Hypercalciuria, defined as >7.5 mmol/day in men and >6.25 mmol/day in women, was observed in 12 (19.4%) patients. Nephrolithiasis and nephrocalcinosis were present in 2 (3.2%) patients each. No patient had chronic kidney disease (CKD), defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Conclusion: Conventional management for permanent postsurgical HypoPT appears suboptimal for certain patients. However, the incidence of renal complications, such as hypercalciuria, nephrolithiasis/nephrocalcinosis, and CKD, was not commonly observed in a real-world setting during the 10 years of follow-up. This observation may be associated with a higher prescription rate of thiazide diuretics. Presentation: 6/2/2024

Hypomagnesemia as a predictor of the efficacy of combination EGFR-targeted drugs versus EGFR ADCs alone in HNSCC.

146 Background: EGFR-targeted drugs and ADCs in combination with EGFR-conjugated chemotherapy drugs can both cause hypomagnesemia. However, the predictive value of hypomagnesemia in response to treatment for head and neck squamous cell carcinoma (HNSCC) is unclear. Methods: This study retrospectively analyzed patients who participated in clinical trials of EGFR-targeted drugs and EGFR ADCs for HNSCC and solid tumors, from February 24, 2022, to March 25, 2024. The primary endpoint of the study was time to treatment failure (TTF). Results: This study conducted a retrospective analysis of 68 patients . All patients exhibited normal baseline serum magnesium levels prior to treatment, but following two cycles of treatment, varying degrees of hypomagnesemia were observed among them. Among the 46 patients who received 2 cycles of combination therapy with EGFR-targeted drugs, 33 were hypomagnesemia and 13 were normal serum magnesium, ORR[90.9%vs. 8.5%,(P=0.002)] (Table), TTF [151 days (95% CI: 212-380) vs. 87 days (95% CI: 52-230), HR 0.576 (95% CI: 0.270–1.230,P = 0.021)]. Among the 22 patients who received EGFR ADC alone for 2 cycles, 8 were hypomagnesemia and 14 were normal serum magnesium, ORR [37.5% vs.28.6%, (P=0.549)] (Table), TTF [97.5 days (95% CI: 68-300) vs. 108.5 days (95% CI: 60-160), HR of 0.877 (95% CI: 0.339–2.263; P = 0.547)]. Conclusions: The study demonstrates that, the occurrence of hypomagnesemia is associated with ORR and TTF following two cycles of combination of EFGR-targeted drugs, not observed in patients receiving EGFR ADCs as monotherapy in HNSCC. [Table: see text]

To study the haemoglobin levels in patients with hypomagnesemia suffering from type 2 diabetes mellitus.

Objective: To study the association of anemia with serum magnesium levels in diabetic type 2 patients. Study Design: Cross Sectional Retrospective study. Setting: Department of Physiology of Sindh University Jamshoro in collaboration with the Diabetic OPD of Liaquat University Hospital Hyderabad. Period: January 2022 to June 2022. Methods: The data size comprised 300 patients suffering from diabetes mellitus type 2. They were divided into two groups. The control group comprised of 160 type 2 DM patients with normal serum magnesium levels and the test group comprised of 140 patients with decreased serum magnesium levels. The serum magnesium level was determined by Roche C311 auto analyzer while the hemoglobin level was measured by Sahli’s hemoglobinometer. Results: Type 2 Diabetic patients with normal serum magnesium level shows 18.75% decrease haemoglobin level while Type 2 Diabetic patients with hypomagnesemia showed 32.15% decrease in haemoglobin level. The P value was 0.01. The odds ratio was 2.05. Conclusion: Diabetes mellitus leads to hypomagnesemia and Hypomagnesia produces anemia due to hemolysis.

A Rare Compound Heterozygous Mutation of TRPM6 Gene in Hereditary Hypomagnesemia with Secondary Hypocalcemia: A Cause of Refractory Seizures in an Infant

Background: Hypomagnesemia is an important cause of refractory hypocalcemic seizures. Among the causes of hypomagnesemia, genetic defects are rare. Clinical Description: A 20-month-old boy presented with a history of repeated hypocalcemic convulsions since 1 month of age. Besides seizures, the infant was thriving well and otherwise asymptomatic. Management and Outcome: On investigation, he had low serum calcium, normal vitamin D, low parathormone, and very low serum magnesium (0.5 mg/dl) levels, with normal sodium, potassium levels, and renal functions. The child was initiated on parenteral magnesium supplementation and subsequently discharged on high-dose oral magnesium supplementation. As further investigations ruled out common causes of hypomagnesemia, clinical exome sequencing was done, which revealed a compound heterozygous state with two variants in the TRPM6 gene NM_017662.5, one being a missense variant (chr9: c.5614T>C, [p.Trp1872Arg]/Heterozygous) and the other being a frameshift deletion (chr9: c.1939_1946delGCAATGGC, [p.Ala647Profs*2]/Heterozygous). The child maintained normal serum magnesium levels at follow-up and was seizure-free. Conclusion: Hereditary hypomagnesemia with secondary hypocalcemia is a rare cause of refractory seizures with onset since early infancy. Here, a compound heterozygous variant of the TRPM6 gene was identified as the cause of this condition.

Effect of Serum Ionic Magnesium on Neurological Outcome in Severe Traumatic Brain Injury Patients: A Prospective Study

Abstract Background Magnesium is considered to have important role in cytotoxic and reperfusion pathways, deficiency of which may lead to secondary brain injuries; thus, hypomagnesemia is thought to be detrimental in traumatic brain injury (TBI) patients. The aim of this study was to evaluate the relationship between serum ionic magnesium level and neurological outcome in severe TBI patients. Materials and Methods Eighty-four patients with severe TBI aged between 20 and 80 years admitted within 24 hours of injury included in our study. All patients were divided into two categories on the basis of initial serum magnesium levels as low serum magnesium level and normal serum magnesium level. Data was collected on the basis of age, gender, Glasgow Coma Scale (GCS) at the time of admission, and neurological outcome evaluation done on the basis of Glasgow Outcome Scale (GOS) at the end of 6 months. Results Among the total patients, 32 patients had low serum magnesium level (< 1.6 mg/dL) at the time of admission. About 87.5% patients with low serum magnesium level had poor neurological outcome as compared to 12.5% of patients (p < 0.001) had good neurological outcome evaluated on the basis of GOS. Logistic regression model identified low Mg level (odds ratio = 6.593, p = 0.002) and GCS score less than 5 (odds ratio = 3.099, p = 0.028) as independent predictors of TBI. Conclusion Hypomagnesemia seems to be an independent prognostic marker in severe TBI that can lead to poorer outcomes.

Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study

BackgroundSepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities.MethodsThis retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission.ResultsAmong 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6–2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60–4.76; P < 0.001).ConclusionsHypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.

Serum Magnesium Levels in Patients Admitted with Septic Shock and Their Correlation with Outcome

Objective: To evaluate the initial serum magnesium levels of critically ill septic shock patients upon admission to the intensive care unit (ICU) and correlate these levels with the patients' requirements and outcomes, including ventilator support, length of stay in the ICU, occurrence of cardiac arrhythmias, and mortality rates.Methods: This was an observational study involving 60 patients who were admitted to the medical Intensive Care Unit (ICU) for septic shock. Serum magnesium levels were measured upon admission to the ICU. A comparison was made between patients with normal and abnormal magnesium levels at the time of admission to evaluate the need for vasopressor support, the average duration of assisted ventilation and dialysis, the incidence of arrhythmia, the average length of ICU stay, and mortality rates.Results: Out of the 60 cases studied, there were 42 males (70.00%) and 18 females (30.00%), resulting in a M:F ratio of 1:0.42. The mean age of both male and female patients was found to be comparable. The need for assisted ventilation and renal replacement therapy was found to be comparable in patients with normal and abnormal serum magnesium levels. The number of days for which assisted ventilation was required, the incidence of arrhythmia, the mean duration of ICU and hospital stay, and mortality were significantly higher in patients with abnormal magnesium levels at the time of ICU admission (P&lt;0.05).Conclusion: Abnormal serum magnesium levels are associated with increased morbidity and mortality in critically ill septic shock patients admitted to the ICU.

Оцінка ефективності магній-калієвого комплексу в корекції стану здоров’я дітей, які перенесли COVID-19

The health status of children and adolescents after an acute episode of COVID-19, namely the post-acute and long-term consequences of SARS-CoV-2, is an urgent medical problem. The pathogenesis of the development of the post-covid state has not yet been fully studied and includes various links, including a violation of the constancy of the levels of various macroelements in biological tissues and blood. Since the leading role in ensuring the proper functioning of energy and synthetic processes in the body belongs to magnesium, it is assumed that the development of post-covid state may be associated with hypomagnesemia. Purpose - to evaluate the level of magnesium in the blood serum of children who have suffered from COVID-19, to analyze their state of health, level of tolerance to physical exertion, and quality of life; to optimize approaches to the correction of detected violations, by prescribing a magnesium-potassium complex, and to evaluate its effectiveness. Materials and methods. 75 children aged 6 to 18 took part in the study. Among them, 60 children with a confirmed diagnosis of COVID-19 in the anamnesis and a period after COVID-19 more than 12 weeks and 15 somatically healthy children of the same age did not suffer from COVID-19 (control group). Children with COVID-19 were divided into a main group (35 children who had reduced serum magnesium levels) and a control group (25 children with normal magnesium levels). The research was conducted in two stages. In the first stage, the health status of children who suffered from COVID-19 was analyzed. The second stage of the study involved the appointment of PANCICOR magnesium-potassium complex to children of the main group and the evaluation of the effectiveness of its use on the 60th day of treatment. General clinical (analysis of anamnesis data, Rufier test results, questionnaire), laboratory (determination of magnesium level in blood serum), instrumental (cycle ergometry), and statistical research methods were used. Results. Magnesium deficiency is a common disorder of macronutrient homeostasis in children who have experienced COVID-19. Post- covid syndrome was detected in 28.3% of children. At the same time, the proportion of post-covid state detection was higher in the group of children with magnesium deficiency compared to the group of children with normal serum magnesium levels. The level of tolerance to physical exertion and indicators of quality of life in children who suffered from COVID-19 are significantly lower (p&lt;0.05) compared to children in the control group who did not suffer from COVID-19. The analysis of the parameters of the health status of children on the 60th day of taking the magnesium-potassium complex PANCICOR showed a positive effect of the drug on the characteristics of the state of health that were studied. In particular, on the 30th day of treatment, no child noted the manifestations of the post-covid condition. Indicators of the quality of life and tolerance to physical exertion statistically significantly increased and improved (p=0.002 and p=0.005, respectively) compared with the results at the initial visit. Conclusions. The use of the magnesium-potassium complex allows you to influence the basic links of the pathogenesis of the post-covid state and the consequences of the transferred COVID-19 associated with magnesium deficiency, as well as to promote the restoration of the adaptive reserves of the body after an acute episode of COVID-19. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent from the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

A case of infantile hypophosphatasia: Phenotypic findings of a compound heterozygous inheritance with a novel mutation

We report the case of a 9-month infant who presented with failure to thrive and bony deformities, mimicking a ricket-like picture. Biochemical parameters showed hypercalcemia, low serum alkaline phosphatase, normal serum phosphorus, magnesium, and parathormone levels. Ultrasound revealed nephrocalcinosis. Clinical exome sequencing revealed infantile hypophophatasia with two compound heterozygous mutations in exon 6 (mutation being novel) and 12. To the best of our knowledge, compound heterozygous mutations in exon 9 and exon 12 have presented with pyridoxine responsive seizure (PRS) along with hypophosphatasia (HPP). This is the third case of infantile HPP reported from India, but with a novel mutation who had not yet manifested with PRS.

Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study

BackgroundHypomagnesemia reportedly has significant associations with poor clinical outcomes such as increased mortality and septic shock in patients with sepsis. Although the mechanism underlying these outcomes mostly remains unclear, some experimental data suggest that magnesium deficiency could potentiate coagulation activation in sepsis. However, in sepsis, the association between serum magnesium levels and coagulopathy, including disseminated intravascular coagulation (DIC), remains unknown. Thus, we aimed to investigate the relationship between serum magnesium levels and coagulation status and the association between hypomagnesemia and DIC in patients with sepsis.MethodsThis retrospective observational study was conducted at the intensive care unit (ICU) of a university hospital from June 2011 to December 2017. Patients older than 19 years who met the Sepsis-3 definition were included. We categorized patients into three groups according to their serum magnesium levels: hypomagnesemia (< 1.6 mg/dL), normal serum magnesium level (1.6–2.4 mg/dL), and hypermagnesemia (> 2.4 mg/dL). We investigated the association between serum magnesium levels and overt DIC at the time of ICU admission according to the criteria of the International Society on Thrombosis and Haemostasis.ResultsAmong 753 patients included in this study, 181 had DIC, 105 had hypomagnesemia, 552 had normal serum magnesium levels, and 96 had hypermagnesemia. Patients with hypomagnesemia had a more activated coagulation status indicated by lower platelet counts, lower fibrinogen levels, higher prothrombin time-international normalized ratios, higher thrombin-antithrombin complex, and more frequent DIC than those with normal serum magnesium levels and hypermagnesemia (DIC: 41.9% vs. 20.6% vs. 24.0%, P < 0.001). The coagulation status in patients with hypomagnesemia was more augmented toward suppressed fibrinolysis than that in patients with normal serum magnesium levels and hypermagnesemia. Multivariate logistic regression revealed that hypomagnesemia was independently associated with DIC (odds ratio, 1.69; 95% confidence interval, 1.00–2.84; P = 0.048) after adjusting for several confounding variables.ConclusionsPatients with hypomagnesemia had a significantly activated coagulation status and suppressed fibrinolysis. Hypomagnesemia was independently associated with DIC in patients with sepsis. Therefore, the treatment of hypomagnesemia may be a potential therapeutic strategy for the treatment of coagulopathy in sepsis.

Effect of magnesium on severity and mortality of COVID–19 patients

Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.

A study of serum magnesium levels in acute myocardial infarction and its association with clinical outcome

Background: Cardiovascular disease is one of the leading causes of mortality, morbidity, and increased health-care cost. Magnesium has been implicated in the pathogenesis of acute myocardial infarction (AMI) and its complications. Magnesium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium concentration was found to have great significance in AMI. The present study was undertaken to evaluate the prognostic value of serum magnesium in AMI. Aim and Objectives: The aim of the study was (1) to evaluate serum magnesium levels in patients of AMI on 1st and 7th day post-myocardial infarction and (2) to evaluate validity of serum magnesium as prognostic indicator of Ami. Materials and Methods: This observational cross-sectional study was conducted in the Medicine Department, Guru Nanak Dev Hospital attached to Govt. Medical College, Amritsar. A total of 40 patients of AMI were enrolled in this study. Serum magnesium levels were done for all the patients and its correlation with clinical outcome was observed. Results: On day 1, mean serum magnesium levels in patients with ST-segment elevation myocardial infarction were 1.638 ± 0.19 whereas mean serum magnesium levels in patients with Non-ST-segment elevation myocardial infarction were 2.315 ± 0.321. Mean serum magnesium levels in patients with arrhythmias were 1.73 ± 0.35 on day 1 and 2.14 ± 0.25 on day 7 (P &lt; 0.05). Mean serum magnesium levels at day 1 in patients having mortality are 1.452 ± 0.078 as compared to 2.105 ± 0.399 in rest of surviving patients. It was inferred from this study that patients with AMI with low serum magnesium levels are more prone to develop complications such as arrhythmias and death as compared to patients of AMI with normal serum magnesium levels. Conclusion: Magnesium is an underestimated cation and has been implicated in the pathogenesis of AMI and its complications. Patients of AMI with low serum magnesium levels are found to be more prone to develop arrhythmias as compared to those with normal serum magnesium levels. Hence, it can be concluded that measurement of serum magnesium level is of prognostic significance in AMI.

Vitamin D deficiency in proximal femur fractures: An observational, cross-sectional study

Introduction: A proximal femur fracture is the most serious complication of osteoporosis, due to the high mortality and morbidity associated with it. Its risk in the elderly is a function of multiple factors, including bone mineral density, muscle strength, and balance, all of which have been related to Vitamin D status and function. Materials and Methods: This was a prospective hospital-based study conducted over 2 years in the hilly state of Himachal Pradesh, India, to evaluate any correlation between Vitamin D levels and proximal femur fractures (PFFs). We also studied the influence of age and sex on Vitamin D levels in PFFs. Results: In our study, the female patients had lower Vitamin D levels (19.85 ± 5.28) as compared to males (20.436 ± 9.36), but this decrease was not found to be statistically significant (P = 0.2374). There was an average decrease of Vitamin D levels in patients of higher age group (20.770 ± 6.57 vs. 19.692 ± 8.40), but this was not statistically significant (P = 0.613). Thirty-four patients, i.e., 68%, had hypocalcemia, while 16 patients, i.e., 32%, had normal levels of serum calcium. Similarly, 30 patients, i.e., 70%, had hypomagnesemia, while 20 patients, i.e., 40%, had normal serum magnesium levels. The mean level of alkaline phosphatase in PFF was found to be 116.36 IU/L, i.e., within normal limits. The average Vitamin D level in our patients who were adequately exposed to sunlight was 22.5 ± 8.80 ng/ml, while the average Vitamin D level in patients who were inadequately exposed was 16.925 ± 5.98 ng/ml. The mean Vitamin D levels in vegetarian and nonvegetarian patients were 19.17 ± 6.05 ng/ml and 19.83 ± 9.56 ng/ml, respectively. We found that vitamin levels were relatively low (19.46 ng/dL) in patients from high altitudes as compared to patients from low altitudes (22.62 ng/dL), but the difference was insignificant (P = 0.3925). Conclusion: In our study, almost all patients (96%) were suffering from hypovitaminosis D (Vitamin D levels <30 ng/ml), and 38% of our patients had Vitamin D deficiency (Vitamin D levels <20 ng/ml). However, we were unable to find any significant difference in Vitamin D levels when patients of various ages, sex, and altitude were compared with each other.

Avoiding The Severe Gastrointestinal Side Effects Associated with High Dose Potassium and Magnesium Supplementation with Gitelman’s Syndrome Through Utilization of Canagliflozin, Aliskiren and Spironolactone

Gitelman’s Syndrome is an inherited renal tubulopathy that is characterized by renal potassium and magnesium wasting leading to hypokalemia and hypomagnesemia. Previously the only available therapies for the hypokalemia and hypomagnesemia associated with Gitelman’s Syndrome were high dose oral potassium and magnesium supplements. With the availability of the SGLT-2 receptor blocker canagliflozin the need for magnesium replacement therapy can be minimized. Similarly, utilizing blockade of the renin and mineralocorticoid receptors with aliskiren and spironolactone respectively the need for oral potassium replacement can be avoided. By eliminating or reducing the need for oral potassium and magnesium replacement therapy, gastrointestinal problems, particularly diarrhea, can be avoided and the quality of life improved while achieving normal serum potassium and magnesium levels. In addition, by normalizing serum potassium and particularly by correcting serum magnesium levels, the risk of a cardiac arrythmia is also reduced

Role of Magnesium Supplementation in Children with West Syndrome: A Randomized Controlled Clinical Trial.

Objectives West syndrome is a severe epileptic encephalopathy of young age. It is characterized by a clinico-electrical triad of infantile epileptic spasms, regression or arrest of psychomotor development, and hypsarrhythmia. In the last two decades, the large progress in the development of newer antiepileptic drugs has allowed us to have a vast choice of treatment options to control spasms, although they often fail to do so. Thus, there is a need to explore other treatment options.Materials & Methods Subjects in this open-labelled randomized control trial were included newly diagnosed children of age between 3 months and 5 years of both genders. A total of 52 children were recruited and randomized into two groups: an intervention group (n=30) and a non-intervention group (n=22). Magnesium sulphate was provided for the intervention group but not for the non-intervention one. Both groups received the rest of the treatments, including adrenocorticotropic hormone and antiepileptic drugs. The follow-up period was three months, at the end of which a per-protocol analysis was performed.Results There was no significant difference in seizure control and neurodevelopmental outcome between both groups, but electroencephalogram significantly improved in the intervention group compared to the control. Also, the clinical response was better in patients with normal initial serum magnesium levels in the intervention group (p=0.003) than in other patients.Conclusion Magnesium supplementation may be helpful in children with West syndrome.

English

BACKGROUND Menopause is defined as the permanent cessation of menstruation following loss of ovarian activity. One of the most important problems associated with menopause is osteoporosis. This study was conducted to evaluate the relationship between bone mineral density, body mass index, age, serum calcium, and serum magnesium in 120 women. METHODS Present study was an observational study done from Feb 2017 to July 2017 in Pt. J.N.M. Medical College to evaluate the relationship of bone mineral density with age, body mass index (BMI), obesity and serum magnesium in 120 postmenopausal women. A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designed for the study. Past fracture history, family history of fracture and osteoporosis, socioeconomic status, occupation, educational level and weightbearing exercises were collected and recorded. RESULTS Average age of women with normal bone health was 30.5 + 0.58 years, while the age of osteopenic and osteoporotic women was 43.11 + 6.79 years and 54.64 + 11.92 years respectively. Most of the osteopenic women belonged to the age group of 40 – 49 years. Osteoporotic patients (78.57 %) had a high (&gt; 0.85) waist-hip ratio, while women with normal bone mineral density had a normal waist-hip ratio. Most of the women with normal bone mineral density (100 %), osteopenia (85.29 %) and osteoporosis (57.14 %) had normal serum magnesium levels. CONCLUSIONS We found that the bone mineral density reduced with advancing age, decreasing BMI and obesity, while we found no correlation of serum magnesium level with bone mineral density (BMD). KEY WORDS Bone Mineral Density, Body Mass Index, Perimenopause, Magnesium, Calcium

Hyperaldosteronism in a Patient With Gastrointestinal Potassium Wasting

Background: Medical conditions causing hypokalemia can be masked by a diet very rich in potassium. The following case presents a patient who developed new onset symptoms of hypokalemia after immigrating to the United States. Clinical Case: A 35 year old man, native of Mali, had a history of intermittent muscle spasms and serum potassium of 3.0 mmol/L first recognized elsewhere in 2019. He was not on any home medications. He was admitted with postprandial generalized abdominal pain, diarrhea, and bright blood in his stools. Serum potassium was 2.7 (nl 3.5–5.1mmol/L). He required at least 120 mEq of intravenous and oral potassium chloride per day while hospitalized to achieve and maintain serum potassium in the normal range. Colonoscopy found segmental colitis and it was thought that his hypokalemia was due to gastrointestinal losses. However, studies demonstrated urinary potassium wasting. A 1.9 cm nodular mass of the left adrenal gland was found on CT of the abdomen, and the differential diagnosis was expanded to include hypokalemia secondary to primary hyperaldosteronism or renal tubulopathies such as Bartter and Gitleman syndromes. The patient was normotensive and had biochemical findings that were consistent with Bartter syndrome including metabolic alkalosis, hypercalciuria, elevated urine sodium and chloride, and normal serum magnesium levels. However, he had low plasma rennin activity with an elevated serum aldosterone on three tests over two months (the last test was more than one month after normalization of bowel function). On all of these, the aldosterone to renin ratio was greater than 20 ng/mL/hour. The persistent suppression of plasma rennin with elevated aldosterone in the setting of left adrenal mass narrowed the differential diagnosis to primary hyperaldosteronism, as elevated rennin would be expected in Bartter syndrome. Since discharge, he has received 80 meq of daily oral potassium in divided doses, which has kept serum potassium at or below the lower limit of normal. Further management will consist of either pharmacologic or surgical treatment with or without adrenal venous sampling. Conclusion: The patient had hypokalemia for which an endocrine etiology could have been easily overlooked and attributed to gastrointestinal losses. This case demonstrates the very close clinical similarities between primary hyperaldosteronism and renal tubulopathies. However, there are biochemical patterns that can be relied on to help differentiate amongst these disorders. This patient with primary hyperaldosteronism may not have been hypokalemic in his native country due to consuming a diet rich in potassium.

Hospital-acquired dysmagnesemia and mortality in critically ill patients: data from MIMIC-III database.

This study aimed to determine the relationship between hospital-acquired dysmagnesemia and in-hospital mortality in critically ill patients. A retrospective cohort study was conducted on critically ill patients who had normal serum magnesium levels on admission. Data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III database. The normal range of serum magnesium was 1.6-2.6 mg/dL. In-hospital serum magnesium levels were categorized based on the occurrence of hospital-acquired hypomagnesemia and hypermagnesemia. Hospital-acquired hypomagnesemia and hypermagnesemia in the same patient were defined as a patient with the lowest level of serum magnesium of <1.6 mg/dL and the highest level of serum magnesium of >2.6 mg/dL, respectively. The in-hospital outcomes were collected. The findings revealed that 27.2% of patients developed hospital-acquired dysmagnesemia. In-hospital mortalities were 8.8% in patients with persistently normal serum magnesium levels, 12.2% in patients with hospital-acquired hypomagnesemia only, 18.4% in patients with hospital-acquired hypermagnesemia only, and 20.6% in patients with both hospital-acquired hypomagnesemia and hypermagnesemia. Compared to patients with persistently normal serum magnesium in hospital, those with hospital-acquired hypermagnesemia only [odds ratio (OR) = 1.346, P < 0.001] and those with both hospital-acquired hypomagnesemia and hypermagnesemia (OR = 1.333, P = 0.001) were significantly associated with higher in-hospital mortality. Hospital-acquired dysmagnesemia was common among critically ill patients. Hospital-acquired dysmagnesemia, especially hospital-acquired hypermagnesemia, was significantly associated with increased in-hospital mortality in critically ill patients.

Magnesium sulfate toxicity – Are serum levels infallible?

Since a century, we have been using magnesium sulfate for prophylaxis and treatment of eclamptic seizures. There are various regimens followed throughout the world. Although the efficacy is of no doubt, side effects remain a problem. Here, we present a rare case of magnesium toxicity with normal serum magnesium levels.