Normal Serum Magnesium Levels Research Articles

Hypomagnesemia Is Associated with an Increased Risk of Failure in Patients Diffuse Large B-Cell Lymphoma Undergoing Autologous Stem Cell Transplantation

Magnesium is an essential element that is involved in the regulation of cell growth, division and differentiation. Epidemiologic studies have demonstrated that a diet poor in magnesium is associated with an increased risk of developing cancer. There are few studies investigating whether magnesium deficiency is associated with a poor prognosis in lymphomas. The recent discovery of X-linked immunodeficiency with magnesium defect, Epstein-Barr virus, and neoplasia (XMEN) disease, suggests a role of magnesium in the development of hematologic malignancies and lymphocyte function. Furthermore, a recently published study found that hypomagnesemia prior to chemotherapy is associated with inferior overall survival (OS) in patients with Burkitt Lymphoma. We hypothesized that low magnesium levels prior to autologous hematopoietic stem cell transplant (AHSCT) may lead to inferior outcomes via impaired lymphocyte recovery. We evaluated whether low serum magnesium levels were associated with inferior survival in patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) who underwent autologous hematopoietic stem cell transplant (AHSCT) between January 1998 and May 2020 using a retrospective study design. We cross-referenced our search with patients who had a magnesium level as part of their pre-transplant workup between 7 and 28 days prior to their first transplant. Two-sided Wilcoxon rank sum test and Chi square/Fischer's exact test were used to compare the continuous and categorical variables, respectively. Kaplan-Meier and log-rank tests were used to perform all time to event analysis. Hazard ratios (HR) with confidence intervals (CI) were calculated using Cox-proportional hazards. Our study included 581 patients of which 82 (14.1%) had hypomagnesemia (magnesium < 1.7 mg/dL) prior to AHSCT. Our study found that hypomagnesemia was associated with inferior OS and event-free survival (EFS) defined as re-transplant, relapse or death, compared to those with a normal magnesium level; median OS: 7.3 years (95% CI: 2.91 - upper limit not estimable) versus 9.7 years (95% CI: 6.92 - 12.3 years), p=0.0041; and median EFS: 3.9 years (95% CI: 1.63 - 8.98 years) versus 6.29 years (95% CI: 4.73 - 8.95 years), p = 0.016 respectively(B). Higher serum magnesium (HR 0.199 per doubling, 95% CI 0.078 - 0.503; p<0.001) and higher albumin (HR 0.090 per doubling, 95% CI 0.021 - 0.394; p=0.001) were associated with lower mortality rates, and higher creatinine (HR 1.669 per doubling, 95% CI 1.03 - 2.52; p=0.04) was associated with greater mortality up to 1 year post-transplantation. In a multivariate Cox regression excluding albumin, hypomagnesemia (p < 0.001) and elevated creatinine (p = 0.038) were independent predictors of poor overall survival(A). There was no significant difference between day 15 absolute lymphocyte count between patients with normal magnesium levels and low serum magnesium levels prior to their conditioning regimen. Although we hypothesized that we would find a significant difference between 15 day absolute lymphocyte count recovery and hypomagnesemia, this was not apparent. However, magnesium is an important nutrient for immune function and immune recovery is important after the bone marrow is restored post ablative therapy. Thus, low serum magnesium levels may lead to impaired OS and EFS via impaired lymphocyte function. In vitro studies will be necessary to understand this mechanism further. Magnesium may simply be a marker of illness and replacement of magnesium may not improve outcomes. However, further investigations are needed to determine whether outcomes would improve with replacement of magnesium in patients with hypomagnesemia, which our study did not address. Overall, our preliminary data suggests that hypomagnesemia is an independent prognostic factor and predictor of inferior OS and EFS in this cohort of patients. Figure Disclosures Ansell: ADC Therapeutics:Research Funding;AI Therapeutics:Research Funding;Trillium:Research Funding;Affimed:Research Funding;Regeneron:Research Funding;Seattle Genetics:Research Funding;Bristol Myers Squibb:Research Funding;Takeda:Research Funding.Witzig:Spectrum:Consultancy;Celgene:Consultancy, Research Funding;Immune Design:Research Funding;Karyopharm Therapeutics:Research Funding;Acerta:Research Funding;Incyte:Consultancy;AbbVie:Consultancy;MorphSys:Consultancy.

Study of Serum Magnesium level and Atherosclerotic Changes in Patient on Maintenance Hemodialysis

Background: Cardiovascular complications in dialysis patients focused on atherosclerosis. Serum magnesium has a role in cardiovascular complications in dialysis patients. Objectives: This study aimed to study the correlation between serum magnesium level and atherosclerotic changes in patients on maintenance hemodialysis. Patients and methods: This prospective study included 60 patients with end-stage renal disease patients on maintenance HD, divided into Group I: (20 patients) with normal serum magnesium level (1.7 -2.8 mg/dl), Group II (20 patients) with low serum magnesium level ( 2.8mg/dl.). Serum magnesium and lipid profile and intima-media thickness (IMT) of both common carotid arteries were measured. Results: Our results showed a significant negative association between level of serum Mg and IMT complex of both common carotid (P = 0.045) and ischemic heart disease in the studied patients (P = 0.012). The binary logistic regression for the predictors for IHD and CCA-IMT, we found that serum magnesium not an independent factor for atherosclerosis but we found that age and DM (P ˂ 0.001) followed by cholesterol and triglycerides (P ˂ 0.05) are the most independent factors for CCA-IMT. Also, age (with OR: 95% confidence Interval) (0.145:1.26-1.06) (P ˂ 0.001) and triglycerides (1.02:1.05-1.002), (P ˂ 0.05) are the independent factors for IHD. Conclusion: Our study revealed a significant inverse correlation between level of serum Mg and CCA-IMT and IHD in the studied HD patients. Thus, we suggest that regular screening of HD patients for serum Mg and CIMT with special consideration to diabetic and old patients is recommended to stratify their CV risk.

Study of Serum Magnesium level and Atherosclerotic Changes in Patient on Maintenance Hemodialysis

Background: Cardiovascular complications in dialysis patients focused on atherosclerosis. Serum magnesium has a role in cardiovascular complications in dialysis patients. Objectives: This study aimed to study the correlation between serum magnesium level and atherosclerotic changes in patients on maintenance hemodialysis. Patients and methods: This prospective study included 60 patients with end-stage renal disease patients on maintenance HD, divided into Group I: (20 patients) with normal serum magnesium level (1.7 -2.8 mg/dl), Group II (20 patients) with low serum magnesium level ( 2.8mg/dl.). Serum magnesium and lipid profile and intima-media thickness (IMT) of both common carotid arteries were measured. Results: Our results showed a significant negative association between level of serum Mg and IMT complex of both common carotid (P = 0.045) and ischemic heart disease in the studied patients (P = 0.012). The binary logistic regression for the predictors for IHD and CCA-IMT, we found that serum magnesium not an independent factor for atherosclerosis but we found that age and DM (P ˂ 0.001) followed by cholesterol and triglycerides (P ˂ 0.05) are the most independent factors for CCA-IMT. Also, age (with OR: 95% confidence Interval) (0.145:1.26-1.06) (P ˂ 0.001) and triglycerides (1.02:1.05-1.002), (P ˂ 0.05) are the independent factors for IHD. Conclusion: Our study revealed a significant inverse correlation between level of serum Mg and CCA-IMT and IHD in the studied HD patients. Thus, we suggest that regular screening of HD patients for serum Mg and CIMT with special consideration to diabetic and old patients is recommended to stratify their CV risk.

Hospital-Acquired Dysmagnesemia and In-Hospital Mortality.

Background and Objectives: This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. Materials and Methods: We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7–2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. Results: 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; p < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; p < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; p < 0.001) were significantly associated with higher in-hospital mortality. Conclusions: Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality.

Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose-Response Meta-analysis of Prospective Cohort Studies.

The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose-response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD). PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity. Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1-28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51-0.80] and 0.90 [95% CI: 0.84-0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57-0.85) and 0.86 (95% CI: 0.77-0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88-0.97) and CHD (RR: 0.90, 95% CI: 0.84-0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83-0.96) and CHD (RR: 0.92, 95% CI: 0.82-0.98). Serum/dietary Mg level comparisons presented a 7%-10% decrease in CVD/CHD risk. The dose-response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440). Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.

Serum Magnesium Level among the Patients Admitted with Acute Stroke in a Tertiary care Hospital

Magnesium deficiency was shown to trigger vasoconstriction and enhance vascular endothelial injury, thus promoting the development and progression of atherosclerosis. We hereby intended to investigate serum magnesium in the early stage of acute stroke and to evaluate the relationship between serum magnesium concentration and the development of neurological deficits. This is a descriptive type of cross sectional study was carried out in department of medicine, Comilla Medical College Hospital from June 2013 to December 2013. Fifty admitted acute stroke patients were randomly chosen for this study who fulfills inclusion criteria. The serum magnesium concentrations were measured by photometric colorimetric end point method on admission. Out of 50 acute stroke patients 30 (60%) were male and 20 (40%) were female. The mean age is 66.44 (SD ±14.8) years with male predominance. Most of the patients 30 (60%) belongs to above 60 years and 36 (72%) patients had hypomagnesaemia and 14 (28%) had normal serum magnesium level. Serum magnesium level more low in ischemic stroke (56%) . The mean serum magnesium level was 1.59 (SD ±0.37) mg/dl in all stroke patient and 1.47 (SD ±0.32) mg/dl in ischemic stroke patient was and was 1.83 (SD ±0.34) mg/dl in hemorrhagic stroke patients. Among 33 ischemic stroke patients mostly 17 (34%) patients had serum magnesium level between 1.0-1.4 mg/dl and in hemorrhagic stroke patients maximum 05 (10%) serum magnessium level was in between 1.5-1.8 mg/dl (P-value 0.0017 HS). In our study most of the patients with acute stroke were improved with marked residual disability were [19 (38.0%)], improved with minimal residual disability were [08 (16%)], improved without residual disability [04 (08%)] and death [03 (6%)] having hypomagnesaemia compared to the patients who have normal serum magnesium level with maximum improvement with minimal residual disability were [10 (20.0%)], improved without residual disability were [06 (12%)], improved with marked residual disability and death were [0 (0%)]. Gross clinical outcome disability of acute stroke patients was worse who had hypomagnesaemia (P-value 0.001 significant). Magnesium levels are significantly decreased in acute stroke; both in ischemic stroke patients as well as in patients of hemorrhagic. Patients with low serum magnesium level in acute stroke associated with worse clinical outcome.TAJ 2014; 27(1): 50-56

An observational study on effects of hypomagnesemia among critically ill patients at a tertiary care hospital

Background: Magnesium is the fourth abundant cation in the human body and second most abundant intracellular cation after potassium and also serving as cofactor in more than 300 enzymatic reactions. Magnesium deficiency is the most commonly overlooked condition in critically ill patients and associated with other coexisting electrolyte abnormalities. The aim of the present study was to evaluate serum magnesium levels in critically ill patients and to correlate with patient outcome and other parameters like length of stay in ICU, ventilator support, APACHE-II score and duration and mortality.Methods: A two years observational study after ethical committee approval was conducted at a tertiary care hospital among critically ill patients admitted in ICU. Serum magnesium levels and other relevant investigations were performed within 24 hours of admission. Patients management and progress were followed till the outcome. The data was analysed by using SPSS software version 16.0 for windows.Results: Total of 150 patients with 102 males and 48 females were enrolled. 97 cases (64.7%) of hypomagnesemia were observed and 11 cases of hypermagnesemia and 42 cases with normal serum magnesium levels were observed. Hypomagnesemia cases were compared with normal cases and found that: Hypomagnesemia cases had higher mortality rate, higher APACHE II score, more length of hospital stay and ventilator duration. Significant association was identified with diabetes and chronic alcoholism (p valve &lt;0.05).Conclusions: Monitoring of magnesium levels in critically ill patients has several prognostic and therapeutic implications and should be recommended as a regular parameter as it is commonly out looked condition. Statistically significant association of hypomagnesaemia was found with hypocalcaemia, hypoalbuminaemia, septicaemia, diabetes and chronic alcoholism. Higher APACHE II score is associated with higher mortality and more length of stay in ICU among the cases of hypomagnesaemia.

Hyopomagnesemia in Critically Ill Children

Objectives: To investigate the incidence of hypomagnesemia, hypomagnesemia-associated risk factors, and the effect of hypomagnesemia effect on prognosis among patients followed at pediatric intensive care unit. Methods: This study enrolled patients who were admitted to the Pediatric Intensive Care Unit between January and December 2017. Patients' admission serum Mg level was measured, and a level below 1.8 mEq/L was considered hypomagnesemia. Patients with hypomagnesemia were grouped as group 1 and those with normal serum magnesium level as group 2. Results: A total of 59 (39.9%) of the 148 patients were female and 89 (60.1%) were male; the mean age was 62.82 ± 72.8 (min: 2 – max: 245) months. Compared with the normomagnesemic patients, those with hypomagnesemia had a greater mean age (P: 0.04), PRISM score (P: 0.015), duration of intensive care unit stay, (P: 0.001), mechanical ventilator need (P: 0.016) and the number of days connected to mechanical ventilator (P: 0.027), having nasogastric drainage (P: 0.02), and mortality rate (P: 0.041). No significant difference was found between the groups with respect to diuretic use. Increase risk of hypomagnesemia by nasogastric drainage was not significant (P: 0.082). The rates of hypokalemia, hypocalcemia, hypophosphatemia, and hypoalbuminemia were significantly greater in group 1 (P < 0.05). Hypokalemia increased the risk of hypomagnesemia by 5.13 times, hypophosphatemia by 21.8 times, hypoalbuminemia by 5.12 times, and nasogastric drainage by 3.01 times. Conclusions: It should be noted that hypomagnesemia might be common and associated with mortality among patients admitted to pediatric intensive care units. Therefore, serum magnesium level should be closely monitored.

Serum Magnesium Concentration Is Inversely Associated with Albuminuria and Retinopathy among Patients with Diabetes.

Aim. To investigate the association between serum magnesium levels and microvascular complications among patients with diabetes. Methods. Patients with diabetes were recruited between April 2012 and January 2015. All patients received an assay of serum magnesium concentration, were screened for 24 h albumin excretion rate, and underwent nonmydriatic fundus photography. Albuminuria and retinopathy were defined accordingly. A total of 3,100 patients with normal serum magnesium levels were included in this study. Results. Patients with albuminuria and/or retinopathy had lower levels of serum magnesium than patients without these complications (P < 0.001). The prevalence of isolated albuminuria, isolated retinopathy, and combined albuminuria and retinopathy decreased as the concentration of serum magnesium increased. Multiple logistic regression analysis indicated that the odds ratio for isolated albuminuria, isolated retinopathy, and concomitant albuminuria and retinopathy decreased by approximately 20% for every 0.1 mmol/L increase in serum magnesium concentration. Conclusion. Serum magnesium levels were negatively associated with the risk of diabetic microvascular complications among patients with serum magnesium levels within the normal range.

Refractory hypocalcemia and hypomagnesemia associated with the use of an oral proton-pump inhibitor in a patient with hypoparathyroidism

The human body physiologically requires gastric acid for efficient absorption of calcium through the small intestine. A proton-pump inhibitor reduces acidity in the stomach, and impairs the absorption of food and therapeutic preparations of calcium salts in the small intestine. Hypomagnesemia is a rare adverse effect of a proton-pump inhibitor. We report a 64-year-old man with a malignant neoplasm of the hypopharynx. After a total pharyngolaryngectomy, bilateral selective neck dissection (levels II, III, and IV), and right thyroidectomy, he developed hypocalcemia, hypomagnesemia, and hypoparathyroidism. After the administration of calcium and magnesium supplements, the patient's serum calcium and magnesium levels were still abnormal. The patient was later found to be taking an oral proton-pump inhibitor (esomeprazole) to treat a peptic ulcer. After discontinuing the oral proton-pump inhibitor, the patient was found to have normal serum calcium and magnesium levels under supplementation with oral calcium and 1,25-dihydroxyvitamin D.

TYPE 2 DIABETES MELLITUS;

Objective: To determine frequency of Hypomagnesaemia in patients of type 2 diabetes mellitus in our population. DataSource: Random selection of DM II patients from Outpatient Department CMH, Kharian. Design: Cross sectional study. Setting:Combined Military Hospital Kharian, Department of Medicine. Duration of study: January 2011 to December 2011. Materials &amp;Methods: We selected outdoor patients of DM-2 from both gender between 40 to 70 yrs of age by random sampling. Those selected,were subjected to blood fasting and random glucose measurements as well as serum magnesium levels. Blood samples were collectedusing full aseptic measures and within one hour, samples were transported to Armed Forces institute of Pathology (AFIP) for analysis.Serum magnesium level estimation was done by timed endpoint method using calmagite dye. DXC 600 automated analyzer was used.The results were verified by Pathologist. Results: The overall frequency of Hypomagnesemia was 32.2% (124 out of the 385 subjects)using the cutoff value of less than 0.6mmol/l for Hypomagnesaemia, whereas 67.8% (261 out of the 385 individual) had normal serummagnesium levels. Conclusions: Significant number of patients with type 2 diabetes mellitus suffers from Hypomagnesaemia. Thesepatients have increased risk risk of poor Glycemic control and diabetic complications due to Hypomagnesemia. Therefore, it isrecommended that serum magnesium levels should be checked regularly in patients with type 2 diabetes mellitus and oral magnesiumreplacement should be done.

Acute Decrease in Serum Magnesium Level after Ischemic Stroke May Not Predict Decrease in Neurologic Function

Higher serum levels of magnesium (Mg2+) may contribute to improved outcome following ischemic stroke, and this may be related to vessel recanalization. Patients with low or normal serum magnesium levels during the acute phase of ischemic stroke may be more susceptible to neurologic deterioration (ND) and worse outcomes. All patients who presented to our center within 48 hours of acute ischemic stroke (July 2008 to December 2010) were retrospectively identified. Patient demographics, laboratory values, and multiple outcome measures, including ND, were compared across admission serum Mg2+ groups and change in Mg2+ from baseline to 24-hour groups. Three hundred thirteen patients met inclusion criteria (mean age: 64.8 years, 42.2% female, 64.0% black). Mg2+ groups at baseline were not predictive of poor functional outcome, death, or discharge disposition. Patients whose serum Mg2+ decreased during the first 24 hours of admission were also not at greater odds of ND or poor outcome measures compared with patients with unchanging or increasing Mg2+ levels. Our results suggest that patients who have low Mg2+ at baseline or a reduction in Mg2+ 24 hours after admission are not at a higher risk of experiencing ND or poor short-term outcome. Ongoing prospective interventional trials will determine if hyperacute aggressive magnesium replacement affords neuroprotection in stroke.

Out-of-Hospital Use of Proton Pump Inhibitors and Hypomagnesemia at Hospital Admission: A Nested Case-Control Study

Case series suggest that long-term use of proton pump inhibitors (PPIs) is associated with hypomagnesemia, but the current literature lacks systematically collected data. Our aim was to examine whether hypomagnesemia at the time of hospital admission is associated with out-of-hospital use of PPIs. Nested case-control study matched for age and sex. Data were collected retrospectively from a tertiary acute-care facility. Eligible cases consisted of 402 adults with hypomagnesemia (serum magnesium <1.4 mEq/L) at the time of hospital admission to medical services, age- and sex-matched with 402 control individuals with normal serum magnesium levels (1.4-2.0 mEq/L). Out-of-hospital PPI use was identified in the hospital record. An omeprazole equivalent dose was calculated when possible. Covariates included the Charlson-Deyo comorbidity index, diabetes, diuretic use, estimated glomerular filtration rate, and gastroesophageal reflux. Multivariable conditional logistic regression analyses were used to examine the association of PPI use with hypomagnesemia at the time of hospital admission. PPI use was not associated with hypomagnesemia (adjusted OR, 0.82; 95% CI, 0.61-1.11). Neither PPI type nor omeprazole equivalent daily dose was associated with hypomagnesemia. Sensitivity analyses of PPI use restricted to patients with esophageal disorders (adjusted OR, 1.00; 95% CI, 0.69-1.45), severe hypomagnesemia (magnesium, ≤1.0 mEq/L; adjusted OR, 0.78; 95% CI, 0.13-4.61), or estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) (adjusted OR, 0.84; 95% CI, 0.53-1.34) were unrevealing. Exposure misclassification; hospitalized patients on medical services may not be representative of a broader ambulatory-based population. In a hospital-based adult population, out-of-hospital PPI use is not associated with hypomagnesemia at the time of hospital admission to medical services. In light of these inconclusive results, prospective cohort studies are needed to address this rare potential medication-related adverse effect.

Serum magnesium and proton-pump inhibitors use: a cross-sectional study

ObjectiveThe aim of this study was to evaluate the association of serum magnesium levels with proton pump inhibitors (PPIs) use and other factors. MethodsThis was a cross-sectional study of 151 patients admitted with acute diseases in the Internal Medicine Division of the Hospital de Clinicas de Porto Alegre, after the exclusion of conditions that are commonly associated with hypomagnesemia: diarrhea; vomiting; chronic alcohol use; severely uncompensated diabetes mellitus; and chronic use of laxatives, diuretics or other drugs causing magnesium deficiency. ResultsAll patients had normal serum magnesium levels. Serum albumin and creatinine levels were positively associated with serum magnesium levels, after adjusting for confounders. There was no difference between mean serum magnesium levels of PPI users and non-users, nor between men and women; there was also no correlation among age, serum phosphorus, and potassium levels with serum magnesium levels. Limitations of this study include the absence of an instrument for measuring adherence to PPI use and the sample size. ConclusionThe association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.

Serum magnesium and proton-pump inhibitors use: a cross-sectional study

ObjectiveThe aim of this study was to evaluate the association of serum magnesium levels with proton pump inhibitors (PPIs) use and other factors. MethodsThis was a cross-sectional study of 151 patients admitted with acute diseases in the Internal Medicine Division of the Hospital de Clinicas de Porto Alegre, after the exclusion of conditions that are commonly associated with hypomagnesemia: diarrhea; vomiting; chronic alcohol use; severely uncompensated diabetes mellitus; and chronic use of laxatives, diuretics or other drugs causing magnesium deficiency. ResultsAll patients had normal serum magnesium levels. Serum albumin and creatinine levels were positively associated with serum magnesium levels, after adjusting for con-founders. There was no difference between mean serum magnesium levels of PPI users and non-users, nor between men and women; there was also no correlation among age, serum phosphorus, and potassium levels with serum magnesium levels. Limitations of this study include the absence of an instrument for measuring adherence to PPI use and the sample size. ConclusionThe association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.

Hypomagnesemia in Adolescents With Eating Disorders Hospitalized for Medical Instability

Hypomagnesemia in patients with eating disorders is poorly characterized, particularly among adolescents. To determine the prevalence of hypomagnesemia (Mg ≤ 1.7 mg/dL) and clinical characteristics of adolescents hospitalized with a DSM-IV-diagnosed eating disorder who developed hypomagnesemia, a retrospective chart review was conducted on all adolescents aged 10-21 years with an eating disorder were hospitalized at a tertiary care children's hospital from 2007 to 2010. Patients were refed orally with standard nutrition and high-energy liquid supplements. Serum magnesium and phosphorus were obtained on admission, every 24-48 hours for the first week, and thereafter as clinically indicated. Clinical characteristics of patients with hypomagnesemia were compared with those of individuals with normal magnesium levels and those with hypophosphatemia. Eighty-six of 541 eligible participants (15.9%) developed hypomagnesemia. Forty (47%) with hypomagnesemia admitted to purging in the year before admission, with 88% purging during the prior month. Compared with those with normal serum magnesium levels, patients with hypomagnesemia were older (P = .0001), ill longer (P = .001), more likely to be purging (P = .04), and more likely to have an alkaline urine (P = .01). They did not differ in eating disorder diagnosis, BMI, or other electrolyte disturbances. Hypomagnesemia developed 4.9 ± 5.5 days after refeeding was initiated, significantly later than the onset of hypophosphatemia, 0.95 ± 2.6 days (P < .001). Hypomagnesemia is prevalent in adolescents hospitalized for an eating disorder and is associated with purging and alkaline urine. Hypomagnesemia develops later in the course of refeeding than hypophosphatemia. Magnesium levels should continue to be monitored after the more immediate risk of hypophosphatemia has passed, especially in those with alkaline urine.

Influence of Urine Output on Magnesium Level in Aneurysmal Subarachnoid Hemorrhage (P02.210)

Objective: To investigate whether high urine output after aneurysmal subarachnoid hemorrhage (aSAH) is associated with a decrease in serum magnesium level. Background Hypomagnesemia frequently occurs in critically ill patients and may be correlated with worse outcome in the subset of aneurysmal subarachnoid hemorrhage (aSAH) patients. These patients are at risk of developing cardiac arrhythmias and cerebral vasospasm, and maintaining normal serum magnesium levels may help to prevent these complications. However, the mainstay of prevention and treatment of cerebral vasospasm includes “Triple-H Therapy” (hypertension, hypervolemia and hemodilution), which may artificially increase patients9 urine outputs and subsequently lower magnesium levels. Design/Methods: A retrospective chart review at an Academic Hospital from July 1 st 2010 to December 31 st 2010 yielded 16 patients with the diagnosis of aSAH. Serum magnesium level, magnesium repletion, total fluid intake and total urine output were recorded daily. Statistical correlation was used for statistical analysis. Results: Of the 16 patients, one patient was excluded from the study due to short hospital stay. Three patients showed strong correlation (r= -0.8831; -0.7039 and -0.5840 respectively) between high daily urine output and low serum magnesium level. All three patients needed multiple magnesium replacements to maintain a stable magnesium level. Six patients showed moderate correlation (r= -0.4021; -0.3976; -0.3657; -0.3557; -0.3285 and -0.3120 respectively), and 6 showed weak and very weak correlation. Daily serum magnesium level tended to fluctuate around the admission magnesium level. Conclusions: There is no significant correlation between daily urine output and daily serum magnesium level. However, there is a tendency that more hypomagnesemia occurs when daily urine output is higher than 5 liters (L). Serum magnesium level tends to fluctuate around the admission level. Admission serum magnesium may indicate the relative magnesium level throughout the acute aSAH period. Disclosure: Dr. Gu has nothing to disclose. Dr. Klinger has nothing to disclose. Dr. Boudreaux has nothing to disclose. Dr. Botros has nothing to disclose. Dr. Griffith has nothing to disclose. Dr. Rickert has nothing to disclose. Dr. White has nothing to disclose. Dr. Samson has nothing to disclose.

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients.

The kidney has a vital role in magnesium homeostasis and, although the renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels. However, in more advanced CKD (as creatinine clearance falls <30 mL/min), this compensatory mechanism becomes inadequate such that overt hypermagnesaemia develops frequently in patients with creatinine clearances <10 mL/min. Dietary calcium and magnesium may affect the intestinal uptake of each other, though results are conflicting, and likewise the role of vitamin D on intestinal magnesium absorption is somewhat uncertain. In patients undergoing dialysis, the effect of various magnesium and calcium dialysate concentrations has been investigated in haemodialysis (HD) and peritoneal dialysis (PD). Results generally show that dialysate magnesium, at 0.75 mmol/L, is likely to cause mild hypermagnesaemia, results for a magnesium dialysate concentration of 0.5 mmol/L were less consistent, whereas serum magnesium levels were mostly normal to hypomagnesaemic when 0.2 and 0.25 mmol/L were used. While dialysate magnesium concentration is a major determinant of HD or PD patients’ magnesium balance, other factors such as nutrition and medications (e.g. laxatives or antacids) also play an important role. Also examined in this review is the role of magnesium on parathyroid hormone (PTH) levels in dialysis patients. Although various studies have shown that patients with higher serum magnesium tend to have lower PTH levels, many of these suffer from methodological limitations. Finally, we examine the complex and often conflicting results concerning the interplay between magnesium and bone in uraemic patients. Although the exact role of magnesium in bone metabolism is unclear, it may have both positive and negative effects, and it is uncertain what the optimal magnesium levels are in uraemic patients.

Severe hypomagnesemia and low-grade inflammation in metabolic syndrome

To evaluate the association between severe hypomagnesemia and the low-grade inflammatory response in subjects with metabolic syndrome (MetS), ninety-eight individuals with new diagnosis of MetS were enrolled in a cross-sectional study. Pregnancy, smoking, alcohol intake, renal damage, hepatic disorders, infectious or chronic inflammatory diseases, malignancy, use of diuretics, statins, calcium antagonist, antioxidants, vitamins, anti-inflammatory drugs, or previous oral magnesium supplementation were exclusion criteria. According serum magnesium levels, participants were assigned to the following groups: 1) severe hypomagnesemia (≤1.2 mg/dL); 2) hypomagnesemia (>1.2≤1.8 mg/dL); 3) Normal serum magnesium levels (>1.8 mg/dL). The low-grade inflammatory response was defined by elevation of serum levels of (hsCRP >1.0 ≤10.0 mg/L) or TNF-alpha (TNF-α ≥3.5 pg/mL). Severe hypomagnesemia, hypomagnesemia, and normomagnesemia were identified in 21 (21.4%), 38 (38.8%), and 39 (39.8%) individuals. The ORs, adjusted by WC, showed that severe hypomagnesemia (OR: 8.1; CI 95%: 3.6-19.4 and OR: 3.7; CI 95%: 1.1-12.1), but not hypomagnesemia (OR: 1.8; CI 95%: 0.9-15.5 and OR: 1.6; CI 95%: 0.7-3.6), was strongly associated with elevated hsCRP and TNF-α levels, and that normomagnesemia exhibited a protective role (OR: 0.32; CI 95%: 0.1-0.7 and OR: 0.28; CI 95%: 0.1-0.6) for elevation of CRP and TNF-α. Results of this study show that, in subjects with MetS, severe hypomagnesemia, but not hypomagnesemia, is associated with elevated concentrations of CRP and TNF-α.

Clinical Vignette: PTH(1–34) Replacement Therapy in a Child With Hypoparathyroidism Caused by a Sporadic Calcium Receptor Mutation

Autosomal dominant hypocalcemia (ADH) is an inherited form of hypoparathyroidism caused by activating mutations in the calcium-sensing receptor (CaR). Treatment with PTH(1-34) may be superior to conventional therapy but is contraindicated in children, and long-term effects on the skeleton are unknown. The patient is a 20-yr-old female with ADH treated with PTH continuously since 6 yr and 2 mo of age. A bone biopsy was obtained for histomorphometry and quantitative backscattered electron imaging (qBEI). Her data were compared with one age-, sex-, and length of hypoparathyroidism-matched control not on PTH and two sex-matched ADH controls before and after 1 yr of PTH. The patient's growth was normal. Hypercalciuria and hypermagnesuria persisted despite normal or subnormal serum calcium and magnesium levels. Nephrocalcinosis, without evidence of impaired renal function, developed by 19 yr of age. Cancellous bone volume was dramatically elevated in the patient and in ADH controls after 1 yr of PTH. BMD distribution (BMDD) by qBEI of the patient and ADH controls was strikingly shifted toward lower mineralization compared with the non-ADH control. Moreover, the ADH controls exhibited a further reduction in mineralization after 1 yr of PTH. These findings imply a role for CaR in bone matrix mineralization. There were no fractures or osteosarcoma. In conclusion, long-term PTH replacement in a child with ADH was not unsafe, increased bone mass without negatively impacting mineralization, and improved serum mineral control but did not prevent nephrocalcinosis. Additionally, this may be the first evidence of a role for CaR in human bone.