Serum Magnesium Levels Research Articles

SGLT2 inhibitors increase low serum magnesium levels in patients with chronic kidney disease immediately after treatment.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown in clinical trials to increase serum Mg2+ levels in patients with type 2 diabetes mellitus. However, it is unclear whether this effect is similarly observed in patients with chronic kidney disease (CKD) and whether such an increase is observed immediately after treatment. Our retrospective observational study included the 62 patients with CKD who started SGLT2 inhibitor therapy at our institution between 2017 and 2022 and who had complete data on serum Mg2+ measurements at baseline and at 1, 3, and 6months after treatment. Patients were divided into three subgroups, stratified by serum Mg2+ levels at baseline. We evaluated the changes in serum Mg2+ levels from baseline to 6months after treatment and the factors associated with these changes. Median eGFR and mean serum Mg2+ at baseline were 33.5mL/min/1.73m2 and 2.03mg/dL, respectively. Treatment with SGLT2 inhibitors significantly increased serum Mg2+ levels immediately from 1month after treatment compared with those at baseline and persisted over 6months, with an overall mean change of 0.13mg/dL from baseline to 6months. This increased effect was observed in the low and middle tertile subgroups, but not in the high tertile subgroup. Multivariate linear regression analysis revealed that baseline serum Mg2+ levels and sodium-chloride differences, as a parameter of acid-base status, were independently associated with these changes. SGLT2 inhibitors increased serum Mg2+ levels in patients with CKD, particularly those with lower baseline Mg2+ levels, potentially improving their prognosis.

Risk factors of seizure and complex seizure in febrile children: a clinical study.

There is some evidence that trace element and mineral deficiencies may promote the occurrence of febrile seizures. However, the role of these elements in the occurrence of complex seizures in children with FS has not been comprehensively investigated. The present study was conducted to evaluate this issue. In a cross-sectional study, 220 patients including 110 febrile and 110 FS children aged 6-60 months were studied. Blood samples were taken and serum zinc, potassium, sodium, magnesium and calcium levels were measured. Demographic and clinical characteristics were also recorded. The patients were similar in age and sex. Higher serum zinc levels decreased the risk of seizure (RR = 0.95, p-value = 0.0001) and complex seizure (OR = 0.96, p-value = 0.03). Higher serum sodium levels decreased the risk of complex seizures (OR = 0.85, p-value = 0.023). Higher serum potassium levels were associated with a lower risk of seizure (OR = 0.55, p-value = 0.035). Serum calcium and magnesium levels were not associated with the risk of seizure and complex seizure. A BMI at the upper end of the normal range decreased the risk of complex seizures (OR = 0.83, p-value = 0.05). Male sex increased the risk of complex seizure (OR = 4.14, p-value = 0.016). Low serum levels of zinc, potassium and sodium are risk factors for seizure and complex seizure in febrile children. Male sex is also a risk factor for complex seizures. The time from fever to seizure was shorter in younger children. Children with a BMI at the upper end of the normal range have a lower risk of having a complex seizure.

Serum Magnesium concentration in normal and preeclamptic pregnancy: A tertiary center experience

Preeclampsia and maternal mortality are more prevalent in underdeveloped nations. Preeclampsia has an estimated 16% incidence rate in Bangladesh, which is extremely high. One of the body's major macronutrients is magnesium. It also serves a multitude of enzymes as a cofactor. This cross-sectional study was done in the department of Biochemistry of Mymensingh Medical College, Mymensingh, from July 2016 to June 2017. This study involved a total of 100 individuals, where 50 preeclamptic patients and 50 healthy pregnant women served as the case and control groups, respectively. The results were shown as mean ±SD. For both the case and control groups, the mean ±SD of serum magnesium levels were 1.75 ±0.22 mg/dl and 1.63 ±0.21, respectively. Comparison of the mean ±SD of serum magnesium in the case and control groups revealed a highly significant difference (P<0.001). Students' unpaired ‘t’ test was used to compute the statistical difference. Mediscope 2024;11(2): 73-76

Association Between Serum Magnesium Levels and Depression in Patients Undergoing Peritoneal Dialysis: A Study Conducted at Handan First Hospital, China.

Depression exhibits notable prevalence among patients affected by chronic kidney disease(CKD) and end-stage renal disease (ESRD). Emerging reports suggest a potential association between magnesium (Mg) levels and depressive symptoms, there has been a surge of interest in exploring Mg supplementation as a complementary measure in depression treatment. In this study our aim is to investigate the correlation between depressive symptoms and serum Mg level in patients undergoing peritoneal dialysis (PD) at Handan First Hospital, China. Additionally, we assessed the diagnostic significance of this relationship and identified pertinent influencing factors. This study comprises a cohort of 140 individuals undergoing PD for a minimum duration of 3 months at the PD center of the Handan First Hospital. The Hamilton Depression Scale (HAMD) served as the assessment tool to evaluate the psychological status of the patients. Serum Mg levels, hemoglobin (Hb), and various demographic and clinical data were collected. Logistic regression and ROC analysis were performed to identify significant predictors of depression. The prevalence of depression was higher in patients with hypomagnesemia (60%) compared to those with normal or elevated Mg levels. Notably, a correlation emerged between abnormal serum Mg levels and the presence of depressive symptoms among individuals undergoing PD. Furthermore, binary logistic regression analysis revealed that serum Mg levels, hemoglobin (Hb) concentration, and unemployment significantly influenced the likelihood of occurrence of depression in patients undergoing PD (P< 0.05). In addition, serum Mg levels demonstrate significant predictive value in anticipating onset of depression, indicating that rectifying low serum Mg levels among patients undergoing PD may serve as a preventive measure against depression. Further research is recommended to explore the therapeutic potential of Mg supplementation in this population.

Study Of Calcium Magnesium And Phosphorus In Hypothyroidism - A Case Control Study

Background: Thyroid disorders are the most common endocrine abnormality in the world secondary to diabetes mellitus. Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. It influences the metabolism of all substrates including minerals. Many studies have shown that mineral metabolism is frequently disturbed in thyroid disorders. Materials and Methods: The study was conducted on sixty newly confirmed hypothyroid cases based on the thyroid profile and sixty euthyroid cases were recruited as controls. Blood samples were collected from all the patients for the estimation of serum T3, T4, FT3, FT4, TSH, calcium, phosphorus and magnesium by auto analyzer method. Modified spectrophotometric micro-method was used to measure Serum copper using Bathocuprine Disulphonate Disodium Salt (BCDS) and Guanidine hydrochloride salt. The Statistical software namely SPSS 18.0, and R environment ver.3.2.2 were used for the analysis of the data. Results: It was found that the levels of serum sodium, potassium and calcium were significantly decreased in cases than the controls. Serum magnesium and phosphorus were significantly elevated in cases than controls. Conclusion: Serum calcium, magnesium and phosphorous levels are significantly altered in patients having hypothyroidism. Thyroid diseases have wide spread systemic manifestations including their effects on bone and mineral metabolism. Also thyroid hormone affects the glomerular filtration rate, renal blood flow, tubular reabsorption and excretion of minerals which have direct effect on Calcium, Magnesium and phosphorous level. Thus monitoring of these minerals in hypothyroid patient will be of great benefit in improving clinical manifestation and can be treated appropriately

The Concurrent Association of Magnesium and Calcium Deficiencies with Cognitive Function in Older Hospitalized Adults.

Background/Objectives: Hypomagnesemia and hypocalcemia are common conditions among older adults that may contribute to cognitive decline. However, most of the existing research has focused primarily on dietary intake rather than the actual serum levels of these nutrients or examined them separately. This study aims to investigate the relationship between hypomagnesemia, hypocalcemia, and the concurrent presence of both deficiencies in relation to cognitive performance among seniors. Methods: A total of 1220 hospitalized patients aged 60 and older were included in the analysis. The participants were categorized into four groups: those with normal serum levels of magnesium and calcium, those with hypomagnesemia, those with hypocalcemia, and those with both serum magnesium and calcium deficiencies. To evaluate the potential influence of age, sex, common comorbidities, and disturbances in magnesium and calcium levels on cognitive performance, two general linear models were employed, using the Mini-Mental State Examination (MMSE) and Clock-Drawing Test (CDT) as dependent variables. Results: After adjusting for age, sex, body mass index, and comorbidities, the mean values for the MMSE and CDT were 23.33 (95%CI: 22.89-23.79) and 5.56 (95%CI: 5.29-5.83) for the group with normomagnesemia and normocalcemia, 22.59 (95%CI: 21.94-23.24) and 5.16 (95%CI: 4.77-5.54) for the group with hypomagnesemia, 19.53 (95%CI: 18.36-20.70) and 4.52 (95%CI: 3.83-5.21) for the group with hypocalcemia, and 21.14 (95%CI 19.99-22.29) and 4.28 (95%CI 3.61-4.95) for the group with both hypomagnesemia and hypocalcemia, respectively. Magnesium and calcium deficiencies contributed to MMSE and CDT variance in the general linear models. Conclusions: Our findings indicate that in addition to age, body mass index, and chronic heart failure, both hypomagnesemia and hypocalcemia are associated with reduced cognitive performance.

Zinc oxide nanoparticle biofortification of lentil seedlings enhances plant growth and zinc bioavailability in rats

This study aimed to evaluate the potential of zinc oxide nanoparticles (ZnO NPs) in the biofortification of lentil seedlings and subsequently improve the Zn status in rats. In the first phase of the study, the effects of various ZnO NPs concentrations (0, 10, 20, 40, 80, and 160 ppm) on the lentil growth, Zn accumulation, and other physiological parameters were investigated. Subsequently, the rats were fed ZnO NP-biofortified lentil seedlings (20 and 160 ppm) to assess their impact on animal health and Zn status. The results highlighted a concentration-dependent response of lentil seedlings to ZnO NPs, with optimal growth observed at 20 ppm, whereas higher concentrations inhibited lentil growth. Pigment and biochemical analyses revealed a complex interplay between chlorophyll, carotenoids, soluble sugars, and proteins with distinct responses to nanoparticle concentrations. Elevated levels of hydrogen peroxide and malondialdehyde of lentil seedlings at high concentrations of ZnO NPs suggest oxidative stress, countered by the upregulation of antioxidant enzymes and increased phenolic compounds. On the other hand. animal studies have showed that ZnO NP-biofortified lentil seedlings enhance serum zinc and magnesium levels in rats without affecting body weight. While serum triglyceride levels of rats decreased in both treatment groups, an elevation in creatinine and a marked increase in aspartate aminotransferase (AST) levels were observed at a higher ZnO NP concentration (160 ppm), indicative of potential kidney and liver stress. Paradoxically, serum iron levels were lower in all groups consuming lentil seedlings than in the control group, suggesting a potential interaction between lentil components and iron metabolism. These findings suggest that ZnO NP-biofortified lentils may be a promising approach to enhance Zn nutrition; however, further investigation is needed to optimize ZnO NPs concentration and assess long-term safety.

EFFECTIVENESS OF MAGNESIUM SULFATE IN TERM NEONATES HAVING PERINATAL ASPHYXIA

In Pakistan, neonatal mortality and morbidity are remarkably high. Birth asphyxia (perinatal asphyxia) is one of the main contributors to this, apart from prematurity, sepsis and other causes. Objective: To assess the effectiveness of magnesium sulfate in term neonates having perinatal asphyxia Methods: This Randomized Controlled Trial was carried out at the Department of Pediatrics, Sheikh Zayed Hospital Rahim Yar Khan from July 2023 to December 2023. The overall sample size was 130 patients (65 patients in each group). Neonates in group A received MgSO through I/V, 3 doses 250mg/kg/dose, 24 hours apart along with standard treatment. Group B was a control group that received 20 ml of normal saline infusion at the same interval with similar supportive and symptomatic treatment with regular monitoring. The outcome in terms of mortality, seizure, early initiation of feed, time to the establishment of full oral feeding, duration of seizures and duration of hospital stay were assessed. All the data was analyzed by using SPSS version 25.Results: In the current study, a total of 130 neonates were enrolled. Among them, moderate asphyxia was observed in 90 (69.23%) patients whereas severe perinatal asphyxia was observed in 40(30.77%) patients. In group A, the mean level of serum magnesium in neonates with moderate asphyxia was 2.81 (±0.20) mEq/L while in neonates with severe asphyxia, it was 2.89 (±0.61) mEq/L. The moderate asphyxia patients in group-A showed significant statistical improvement in terms of seizure control (hours) (14.11±1.22 vs 18.11±1.56; P=0.01), normal cry appearance (Days) (11.1±0.12 vs 13.11±1.29; p=0.03), normal activity appearance (Days) (11.9±0.02 vs12.00±1.51; p=0.01), full oral feed acceptance by sucking (Days) (13.31±0.99 vs 14.61±1.51; p=0.01) and mean hospital stay duration (Days) (14.99±1.66 vs 16.21±1.11; p 0.02). Conclusion: Our study concludes that in asphyxiated newborns, postnatal magnesium sulphate infusion is safe and likely to enhance the short-term neurological prognosis in cases with moderate-grade encephalopathy.

Low dietary magnesium and fiber intakes among women with metabolic syndrome in Kuwait.

Metabolic syndrome (MetS) is a growing health concern among Kuwaiti women. Dietary magnesium and fiber have been implicated in reducing the risk of MetS; however, their specific effects on this population remain underexplored. This study aimed to investigate the association of dietary magnesium and fiber intake with the prevalence of MetS and its components among women in Kuwait. This study included 170 women aged 18-65 (years) recruited from AL-Adan Hospital, Mubarak Hospital, and Riqqa Polyclinic. Data were collected using a modified Semi-Quantitative Food Frequency Questionnaire (SFFQ) to assess dietary intake, and biochemical measurements were performed to evaluate serum magnesium and other metabolic markers. MetS was diagnosed according to International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. Statistical analyses included Mann-Whitney U-tests, chi-square tests, Spearman correlations, logistic and linear regression models, and Cohen's kappa statistics. The prevalence of MetS was 24 and 18% based on the IDF and ATP III criteria, respectively. Women with MetS had significantly lower dietary magnesium and fiber intakes than those in women without MetS (p < 0.001). A strong positive correlation was found among dietary magnesium intake, fiber intake, and serum magnesium levels (r = 0.957, p < 0.001 for magnesium; r = 0.917, p < 0.001 for fiber). Increased dietary magnesium and fiber intakes were linked to reduced odds of developing MetS and its components, except for blood pressure measurements. Cohen's kappa demonstrated a strong agreement (K = 0.70, p < 0.001) between dietary and serum magnesium inadequacy. Increased dietary intakes of magnesium and fiber are associated with reduced odds of developing MetS among Kuwaiti women. These findings support the promotion of magnesium- and fiber-rich diets as preventive strategies against MetS.

Hypomagnesaemia among Diabetic Patients with Chronic Kidney Disease: A Cross-sectional Study

Background: The clinical role of magnesium, especially of hypomagnesaemia, in diabetic and chronic kidney disease patients has been underestimated for many years. Objective: To determine the frequency of hypomagnesaemia in diabetic patients with chronic kidney disease and to investigate the relationship of magnesium level with glycemic and renal status. Methodology: This was a cross-sectional observational study performed on 100 diabetic patients with chronic kidney disease, admitted to BIRDEM General Hospital, Dhaka, Bangladesh, excluding patients with history of chronic diarrhea, laxative abuse, diuretic use, alcoholism and those on dialysis. Several socio-demographic and biochemical parameters were analyzed and compared with magnesium level. Results: Frequency of hypomagnesaemia among the study population was 37% (p= 0.009) and the frequency was found to be increasing with increasing stage of chronic kidney disease. Frequency of hypomagnesaemia was more in patients with uncontrolled fasting blood glucose, post meal blood glucose and HbA1c level (p&lt;0.05). Serum magnesium levels positively correlated with serum creatinine levels (Pearson’s correlation coefficient, r=0.428, p=0.001) and inversely correlated with GFR (Pearson’s correlation coefficient, r= -0.275, p= 0.006). Conclusion: The frequency of hypomagnesaemia among diabetic patients with chronic kidney disease is common. So it would be prudent to routinely monitor for hypomagnesaemia in diabetic patients with chronic kidney. Bangladesh Crit Care J September 2024; 12 (2): 132-137

Neurological manifestations of hypermagnesemia: a narrative review.

Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.

Hypomagnesaemia and Relationship Lipid Profile in Type 2 Diabetes Patients at Janzur Hospital in Libya.

Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality due to the development of complications, especially due to poor glycemic control. Magnesium (Mg) is a crucial element in human health, and its deficiency plays a critical role in the development of lipid abnormalities and the initiation of diabetic complications. The study aimed to evaluate the correlation of hypomagnesemia (Mg) with the alteration of lipid profile patterns and investigate the adverse effects of glycemic control and body mass index (BMI) on magnesium levels among patients with T2DM. A total of 163 subjects whose ages ranged between 35-60 years for both sexes (males and females) were included in this study: 90 type II diabetic patients (40 males and 50 females) and 73 healthy individuals (34 males and 39 females) in Tripoli region, Western Libya. Blood glucose, HbA1c, Magnesium, and lipid profile parameters were biochemically estimated in the study along with the measurement of BMI. All the results were statistically analyzed using SPSS version 25 for applying one-way ANOVA and Person's correlation coefficient tests. The study revealed a significant decrease in serum magnesium levels (1.59 ± 0.47 mg/dL) in T2DM patients compared to the control group (2.21 ± 0.70 mg/dL) (p &lt; 0.01). Significantly elevated levels of blood glucose (140.6 ± 30.95 mg/dL vs. 89.80 ± 12.62 mg/dL, p &lt; 0.01), HbA1c (7.27 ± 2.62% vs. 5.32 ± 0.65%, p &lt; 0.01), cholesterol, triglycerides and LDL cholesterol also observed in T2DM patients compared to healthy individuals. Conversely, HDL cholesterol levels were significantly lower in the T2DM group than in controls (24.44 ± 8.88 mg/dL vs. 47.06 ± 8.75 mg/dL, p &lt; 0.01). There is a relationship between hypomagnesemia, glycemic control, and changed lipid profile in T2DM patients. Further, our results revealed a strong relationship between increased BMI and unfavorable alterations in all biochemical parameters examined.

EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM AND MAGNESIUM LEVELS IN NEWBORNS WITH HYPERBILIRUBINEMIA ADMITTED TO NEONATAL INTENSIVE CARE AT A TERTIARY CARE TEACHING HOSPITAL IN THE KOLHAN REGION OF JHARKHAND

Objectives: Neonatal jaundice is a medical condition causing yellowish skin discoloration, leading to hospital readmissions in the first 2 weeks of life. It affects 60% of full-term babies and 80% of premature infants. Severe jaundice can cause kernicterus and neurological damage. Treatment options include phototherapy, exchange transfusions, or pharmacological therapy. Phototherapy is the safest and most effective treatment, but it can lead to hypocalcemia and hypomagnesemia due to its effect on the pineal gland. The present study shows the effect of phototherapy on serum calcium and magnesium levels in hyperbilirubinemia. Methods: A prospective observational study was conducted on 221 neonates with hyperbilirubinemia who were treated with phototherapy. We measured bilirubin, calcium, and magnesium levels in their blood samples at admission and 48 h after initiation of phototherapy. The data were analyzed using Epi-Info software. Results: Before phototherapy, the mean serum calcium was 8.79±1.44, but it decreased significantly to 8.13±1.67 (p&lt;0.05). Before phototherapy, the mean serum magnesium level was 3.22±0.72 and reduced considerably to 2.56±0.50 (p&lt;0.05). After phototherapy, total serum bilirubin levels reduced dramatically (from 13.07±3.41 to 8.63±3.10) (p&lt;0.05). Conclusion: The present study shown that phototherapy has a significant effect on the levels of serum calcium, magnesium, and total serum bilirubin by reducing the level.

Analysis of changes in serum calcium and magnesium levels during plateletpheresis on different apheresis machines in healthy donors: A cross-sectional study

Abstract: BACKGROUND: The most common observed complication of plateletpheresis procedure is hypocalcemia due to citrate’s chelation of free calcium. Magnesium is also affected by citrate infusion. We have evaluated the impact of plateletpheresis on the total serum calcium (Ca++) and magnesium (Mg++) levels of the donor. MATERIALS AND METHODS: One hundred and thirty-seven healthy plateletpheresis donors were included in the study. Samples were collected from the donor at 0 min (baseline), 30 min, and 60 min, at the end of the procedure and 30 min after completion of the procedure. The pattern of changes in serum Ca++ and serum Mg++ levels at different time points for different apheresis machines (Fenwal Amicus, Fresenius COM.TEC, Spectra Optia, and Hemonetics MCS+) was studied. RESULTS: A significant decline in serum Ca++ and serum Mg++ levels from baseline to the end of the procedure was observed. This decline was observed maximum for Hemonetics MCS+. The baseline values were regained 30 min after completion of the procedure. Difference from baseline values 30 min after the procedure was lowest in amicus in the case of serum Ca++ and COM.TEC in case of serum Mg++. Twenty donors (14.60%) experienced adverse donor reactions. CONCLUSION: Serum calcium and serum magnesium levels decreased transiently during the procedure and regained normal values after 30 min of the completion of the plateletpheresis procedure on all four apheresis machines (whether based on continuous or intermittent centrifugation). Hence, it is concluded from our study that plateletpheresis is a well-tolerated and safe procedure.

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 &amp;gt;7.5 mmol/day in men and &amp;gt;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 &amp;lt;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

Proton pump inhibitor-induced hypomagnesemia, a rare cause of reversible delirium: A case report with literature review.

Hypomagnesemia is associated with multiple electrolyte disturbances such as hypokalemia, hypocalcemia and hypoparathyroidism. Proton pump inhibitors (PPIs) are widely used in gastrointestinal disorders and are generally considered safe by clinicians. However, it is unusual side effect of hypomagnesemia is potentially under-recognized. Delirium is usually thought to be a clue of cerebrovascular disease, and the association between delirium and hypomagnesemia is unexpected. We describe a patient used PPI with hypomagnesemia showed normal parathyroid hormone (PTH) despite hypocalcemia and reversible delirium. To enhance clinicians' vigilance, we performed a literature review on cerebellar syndromes due to hypomagnesemia. A 74-year-old woman was admitted to our hospital with intermittent nausea, vomiting, hand tremors, and delirium. Laboratory analysis showed hypokalemia, hypomagnesemia, and normal parathyroid hormone despite hypocalcemia, physical examination showed horizontal nystagmus and the brain MRI was negative. Surprising, detailed medical history revealed that the etiology was the usage of omeprazole. Omeprazole was discontinued and oral supplementation with magnesium, calcium, and potassium was administered. Delirium quickly disappeared and the serum potassium, magnesium, and calcium levels gradually normalized; at discharge, nystagmus gradually disappeared, and plasma electrolyte levels were stable at follow-up. Hypomagnesemia is associated with a variety of neurological symptoms up to life-threatening conditions if left untreated; as Mg is not present in routine electrolyte panels, hypoparathyroidism, hypokalemia, and delirium may be a clue, and physicians must be alert to consider PPI as a potential cause of unexplained hypomagnesemia, and timely treatment to avoid sequelae.

Elevated serum magnesium levels prompt favourable outcomes in cancer patients treated with immune checkpoint blockers

BackgroundMagnesium deficiency influences the activation and cytotoxicity of immune cells. Nevertheless, whether serum magnesium levels influence the clinical outcomes of immune checkpoint blockers (ICBs) treatment still remains ambiguous. There is an urgent need for clinical research to elucidate the relationship between serum magnesium levels and the outcomes of ICB therapy. Such insights could offer new perspectives on immunotherapy for cancer. MethodsA multi-center retrospective study involving in pan-cancer patients treated with ICBs at three large cancer centers from August 2012 to May 2023 was conducted. The primary objective was to assess the correlation between serum magnesium levels and therapeutic response in patients receiving ICBs, and further evaluate the associations between serum magnesium levels and progression-free survival (PFS) and overall survival (OS). ResultsA total of 1441 patients treated with ICBs, including 1042 with lung cancer, 270 with esophageal cancer, and 129 with Hodgkin lymphoma, were enrolled in this study. We found that patients with elevated serum magnesium levels exhibited a favourable response to ICBs treatment. The optimal cut-off point for serum magnesium level (0.79 mmol/L) was applied for stratifying patients into distinct groups. In the three tumor cohorts, patients in high magnesium level group (Mg2+ ≥ 0.79 mmol/L) had longer PFS and OS than those in low magnesium level group (Mg2+ < 0.79 mmol/L). Univariate and multivariate analyses confirmed that the serum Mg2+ level serves as an independent prognostic factor for cancer patients receiving ICBs therapy. ConclusionOur multi-center study demonstrated that among patients receiving ICBs therapy, those with elevated serum magnesium levels exhibit significantly better clinical outcomes than those with low serum magnesium levels. Further prospective validation studies are needed to confirm these findings.

A study on serum potassium and serum magnesium levels in acute myocardial infarction with special emphasis on rhythm disturbance

Background and objectives. Myocardial infarction (MI) is a severe cardiac event associated with plaque formation in arteries, leading to reduced blood flow to the heart. Arrhythmias, such as bradyarrhythmia or tachyarrhythmia, commonly accompany MI, contributing to its morbidity and mortality. Electrolyte disturbances, particularly potassium and magnesium imbalances, can exacerbate arrhythmic risks in MI patients. This study aimed to assess the incidence of alterations in serum potassium and magnesium levels during acute MI and their correlation with rhythm disturbances. Material and methods. A prospective analytical study was conducted with 150 patients diagnosed with acute MI based on ECG changes and elevated cardiac markers. Serum potassium and magnesium levels were measured, and rhythm disturbances were assessed using continuous cardiac monitoring and standard ECG. Spearman correlation analysis was performed to evaluate the association between serum potassium, serum magnesium, and rhythm changes. Results. The study investigated the demographic and clinical characteristics of participants and the potential relationship between serum electrolyte levels and arrhythmic changes. The mean age of the participants was 54.3 years, with a male predominance (76% male, 24% female). Among the participants, 50.67% had diabetes, 52% had hypertension, and 28% had both conditions. Serum electrolyte analysis showed elevated magnesium levels in 6.66% and elevated potassium levels in 12.66% of patients. Notably, arrhythmic changes in ECG were present in 62% of patients, with sinus tachycardia being the most prevalent (17%). However, statistical analysis revealed no significant correlation between serum magnesium, serum potassium, and rhythm changes (p &gt;0.05). These findings suggest that while arrhythmic changes are common, they are not directly associated with elevated levels of these electrolytes, indicating the need for further investigation into other potential factors influencing arrhythmias in this population. Conclusion. Despite the prevalence of electrolyte disturbances in acute MI patients, this study found no significant association between serum magnesium, serum potassium levels, and rhythm disturbances. Further research is warranted to elucidate the complex interplay between electrolyte imbalances and arrhythmias in MI.

Association of cardiac autonomic nerve function with serum zinc, calcium and magnesium in female hypothyroid patients

Background: Hypothyroidism is related to impaired cardiac autonomic nerve activity with altered levels of serum Zinc (Zn), Calcium (Ca) ‍and Magnesium (Mg).Altered Serum Zn,Caand Mg levels are also associated with autonomic imbalance and may raise cardiovascular risk.Heart rate variability (HRV) is an important marker for assessing cardiac autonomic nerve function(CANF). Objectives: To evaluate the association of serum Zn, Cal and Mglevels withCANF in female hypothyroid patients. Methods: This analytical cross-sectional study was conducted on 40 female hypothyroid patients aged 18-45 years. Thirty apparently healthy women were control. Serum Zn, Ca and Mg levels were estimated by autoanalyzer and CANF was assessed by time domain analysis of HRV recorded by Power Lab 8/35 AD Instruments, Australia. Statistical analysis was done by Independent sample‘t’ test, One way ANOVA followed by post-hoc Bonferroni test and Pearson’s correlation coefficient test. Results: Among time domain parameters of HRV, standard deviation of the RR intervals (SDRR), coefficient variation of RR interval (CVRR), SD rate, standard deviation of the difference between successive RR intervals (SDSD), square root of mean squared differences of successive RR intervals (RMSSD), proportion of RR interval with duration &gt;50 ms (pRR50%) were significantly lower (p&lt;0.05) in all hypothyroid patients as compared to control. On correlation analysis, serum Zn, Ca and Mg were significantly positively correlated with SDSD(p&lt;0.01, p&lt;0.001,p&lt;0.01) RMSSD(p&lt;0.01, p&lt;0.001, p&lt;0.01), pRR50%(p&lt;0.01, p&lt;0.01, p&lt;0.05)and serum Ca was also positively correlated with SDRR(p&lt;0.05) in hypothyroid patients. Conclusion:Serum ZnCa and Mg were associated with cardiac autonomic dysfunction. in female hypothyroid patients. J Bangladesh Soc Physiol 2023;18(1): 27-34

Correlation of serum zinc and magnesium with reduced heart rate variability in male Parkinson’s disease patients

Background: Parkinson’s disease (PD) is a neurological disorder associated with altered cardiac autonomic function. Heart rate variability (HRV) analysis is a tool to assess the cardiac autonomic status. Altered serum zinc (Zn) and magnesium (Mg) levels are observed in PD. The serum Zn and Mg alteration is associated with nerve function impairment. Objective: To evaluate the relationship between serum zinc, magnesium, and time domain measures of HRV in male patients with PD. Methods: This observational analytical cross-sectional study was conducted in 2023on 30 newly diagnosed male PD patients aged 50-60 years. In this study, 30 healthy volunteers were the control. The 30 patients were divided into different categories based on serum mineral levels. The HRV was recorded by Power Lab 8/35, AD Instruments, Australia and the time domain measures of HRV were used in data analysis. The serum Zn and Mg levels were measured by atomic absorption spectrophotometry. Independent sample ‘t’ test and Pearson’s correlation coefficient test were used for statistical analysis and p&lt;0.05 was considered statistical significance. Results: Significantly higher mean HR (Heart rate) (p&lt;0.01) and significantly lower mean RR (Normal to normal QRS complex) interval,CVRR (Coefficient variation of RR interval) (p&lt;0.01), SDRR (Standard deviation of the RR intervals), SDSD (Standard deviation of the difference between successive RR intervals), RMSSD (Square root of mean squared differences of successive RR intervals), pRR50% (Proportion of RR interval with duration &gt;50 ms) (p&lt;0.001)were observed in PD patients compared to control. In PD patients, significantly lower (p&lt;0.001) serum Zn and significantly higher (p&lt;0.01) serum Mg were observed compared to control. In addition,significant decrement was observed in SDRR, CVRR (p&lt;0.05), SDSD, RMSSD, and pRR50% (p&lt;0.01) in hypozincemic PD patients compared to normozincemic patients. On correlation analysis, significant positive correlations of serum Zn were observed with SDRR (p&lt;0.05),SDSD (p&lt;0.001), RMSSD (p&lt;0.001) and pRR50% (p&lt;0.01). Moreover,serum Mg was positively correlated with SDRR (p&lt;0.05) in PD patients. Conclusion: Hypozincemia and magnesium were directly related to reduced HRV in male PD patients. J Bangladesh Soc Physiol 2023;18(2): 63-71