Hypomagnesemia

Hypomagnesemia occurs <1.8 mg / dl (<0.70 mmol / l) in serum magnesium concentration. The causes are inadequate magnesium intake and absorption or increased excretion in the context of hypercalcemia or taking medication such. B. furosemide. The clinical symptoms are often triggered by the accompanying hypokalemia and hypocalcemia and consist arrhythmias, lethargy, tremors, tetany and seizures. The sessions are held by magnesium substitution.

(See also overview of disorders of the magnesium concentration.)

Hypomagnesemia occurs <1.8 mg / dl (<0.70 mmol / l) in serum magnesium concentration. The causes are inadequate magnesium intake and absorption or increased excretion in the context of hypercalcemia or taking medication such. B. furosemide. The clinical symptoms are often triggered by the accompanying hypokalemia and hypocalcemia and consist arrhythmias, lethargy, tremors, tetany and seizures. The sessions are held by magnesium substitution. (See also overview of disorders of the magnesium concentration.) The serum magnesium concentration, even if the concentration is determined on anhydrous magnesium, be normal, although the reserves of intracellular or stored in the bone magnesium are reduced. Etiology Magnesium deficiency usually occurs when the dietary intake is not sufficient, and in addition there is a limitation of renal preservation or the intestinal absorption There are numerous cases of clinically significant magnesium deficiency See table: causes of hypomagnesemia). Hypomagnesemia is common in hospitalized patients and often occurs with other electrolyte imbalance, including hypokalemia and hypocalcemia, jointly. Hypomagnesemia is associated with a decreased uptake in patients with malnutrition or long-term chronic alcoholism. Decreased oral intake is often enhanced due to increased urine output by using one diuretic, which increases the urinary excretion of magnesium. Medications can cause hypomagnesemia. Examples are chronic (> 1 year) use of a protein pump inhibitor and the concomitant use of diuretics. Amphotericin B can cause hypomagnesemia, hypokalemia, and acute renal failure. einzeknen The risk increases with the duration of each of therapy with amphotericin B and the simultaneous application of a nephrotoxic drug. It is less likely that iposomales amphotericin B kidney damage or hypomagnesemia caused. Hypomagnesemia returns generally associated with discontinuation of therapy. Cisplatin may result in increased loss of magnesium by the kidneys, as well as to a generalized decline in renal function. Magnesium losses can be severe and persist despite discontinuation of cisplatin. The setting of cisplatin is still recommended if signs of renal toxicity during therapy occur. Causes of hypomagnesemia basic note alcoholism caused both by inadequate intake and by excessive renal losses Gastrointestinal loss Chronic diarrhea Steatorrhea small intestine bypass Chronic use of proton pump inhibitors Pregnancy (especially 3rd trimester; excessive renal excretion, other factors, physiological usually) lactation (increased magnesium requirement) Primary renal losses Rare diseases unreasonably high magnesium excretion (eg. B. Gitelman syndrome) cause secondary renal losses loop and thiazide diuretics hypercalcemia After removal of a parathyroid tumor diabetic ketoacidosis hypersecretion of aldosterone, thyroid hormone or vasopressin nephrotoxins (z. B. Amphotericin B, cisplatin, cyclosporine, aminoglycosides) Symptoms and complaints The clinical signs are anorexia, nausea, vomiting, lethargy, weakness, personality changes, tetany (z. B. Trousseau- positive or Chvostek sign or spontaneous Karpopedalspasmen, hyperreflexia), tremor, and muscular fasciculation. The neurological symptoms, especially tetany, correlate with the simultaneous occurrence of hypocalcaemia and / or hypokalemia. In EMG myopathic potential, but they are also compatible with hypocalcemia and hypokalemia find. Severe hypomagnesemia may produce generalized tonic-clonic seizures, especially in children. Diagnosis is considered in patients with risk factors and with unexplained hypocalcemia or hypokalemia consider serum magnesium concentration <1.8 mg / dl (<0.70 mmol / l) Hypomagnesemia is diagnosed on the basis of serum magnesium concentration. A heavy hypomagnesemia shows concentrations of <1.25 mg / dl (<0.50 mmol / l). A concurrent hypocalcemia and Hypokalzurie are common. Hypokalemia with increased potassium excretion in the urine and metabolic alkalosis may occur. Magnesium deficiency should be suspected even when serum magnesium concentration is normal in patients with unexplained hypocalcemia or refractory hypokalemia. A magnesium deficiency should be considered in patients with unexplained neurological symptoms and alcoholism, chronic diarrhea or cyclosporine application that cisplatin-based chemotherapy or prolonged treatment with amphotericin B or aminoglycosides. Treatment Oral magnesium salts magnesium sulfate i.v. or i.m. in severe hypomagnesemia or inability to tolerate oral therapy or treatment with endure The magnesium salts is indicated when the magnesium deficiency is symptomatic or below values ??persists <1.25 mg / dl (<0.50 mmol / l). Patients with alcoholism are treated empirically. In such cases, deficits in the range of 12-24 mg / kg are possible. Twice the estimated amount should be given in patients with intact kidney function, since about 50% of the amount ingested magnesium is excreted in the urine. Oral magnesium salts (z. B. magnesium gluconate 500-1000 mg po three times daily) administered for 3-4 days. The oral treatment is limited by the onset of diarrhea. Parenteral administration is patients with severe, symptomatic hypomagnesemia or patients who can not tolerate oral therapy, reserved. Occasionally, patients with alcoholism who can not follow presumably an existing oral therapy, a single injection. When magnesium must be replaced parenterally, it can be a 10% magnesium sulfate (MgSO4) solution i.v. (1 g / 10 ml) or a 50% solution (1 g / 2 ml) i.m. use. The serum magnesium levels should be monitored closely during magnesium therapy, particularly if magnesium is used in patients with renal insufficiency or in repeated parenteral doses. In these patients, the treatment is continued until a normal serum magnesium concentration was achieved. In severe symptomatic hypomagnesaemia (z. B. Magnesium <1.25 mg / dl [<0.5 mmol / l] with cramping or other complaints symptoms), be 2-4 g of magnesium sulfate over 5-10 minutes i.v. applied. When the stop seizures, the dose can be up to a total amount of 10 g repeated over the next 6 hours. After completion of seizures 10 g of magnesium should be infused within 24 hours in 1 l of a 5% dextrose solution. The should be up to 2.5 g follow every 12 hours to compensate for the deficit in the overall body reserve and to prevent further drop in serum magnesium levels a magnesium supplementation. If, although the serum magnesium values ??are ? 1.25 mg / dl (<0.5 mmol / l), but the symptoms are not especially severe, magnesium sulphate can in 5% dextrose solution at an infusion rate of 1 g / hour as a slow infusion within 10 hours given. In mild cases, a gradual hypomagnesaemia magnesium replacement can be achieved by administration of small doses of parenteral within 3-5 days. The substitution takes place until normalization of serum magnesium levels. Concurrent hypokalemia, or hypocalcemia should be specifically addressed in addition to hypomagnesemia. These electrolyte disorders are difficult to correct until the magnesium memory were filled. In addition, hypocalcemia can deteriorate through isolated treatment of hypomagnesemia with intravenous magnesium sulfate as sulfate binds ionized calcium. Important points hypomagnesemia may occur in patients with alcoholism, occur with uncontrolled diabetes and with hypercalcemia or use of loop diuretics. Symptoms include anorexia, nausea, vomiting, lethargy, weakness, personality changes, tetany (z. B. positive Trousseau- or Chvostek sign, spontaneous Karpopedalspasmen, hyperreflexia), tremor and muscular fasciculation. The treatment is performed with magnesium salts as the magnesium deficiency is symptomatic or below values ??persists <1.25 mg / dl (<0.50 mmol / l). It will be given oral magnesium salts, unless the patients have seizures or other serious symptoms; Then 2-4 g of magnesium sulfate i.v. given over 5-10 minutes.

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