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All fields are required for calculation accuracy. Hypomagnesemia and hypermagnesemia. Clinical Nephrology, Vol. SEELIGDivision of Nephrology and Department of Medicine, the. University of Southern California School of Medicine, Los. Angeles, California, and the Department of Medicine, the. Goldwater Memorial Hospital, New York University Medical Center. New York, New York, U. With the availability of reliable. The conditions associated with hypo- and. However, Mg. deficiency may exist with normal or elevated levels of Mg in. The normal concentration of Mg. Eq/l. About 2. 0- 3. Mg in blood is bound to proteins. The major part of the diffusible fraction is made of free. Mg . The kidney plays an important role in. Mg within the normal range. Oral or intravenous. Fitzgerald and Fourman 1. Only 3- 5% of filtered Mg is excreted in. This conservation process is due to an effective. Mg. Magnesium is actively reabsorbed throughout the nephron. Mg reabsorption may occur in the proximal. There is a maximum tubular reabsorptive capacity for Mg. Tm Mg). The tubular reabsorption of Mg may be reduced by various. These include: 1) extracellular fluid volume expansion. Parathyroid. hormone enhances tubular reabsorption of Mg. Available data regarding Mg secretion by the renal tubule are. However, the body of evidence indicates that if Mg. Mg. For more detailed information on the renal. Mg, the reader is referred to the extensive review of. Walser . A state of Mg deficiency with hypomagnesemia. Heaton et al. 1. 96. Savage and Mc. Adam 1. King and. Stanbury 1. Massry et al. 1. 95. Mendelson et al. Severe and prolonged dietary restriction. Eq/day) in man can cause hypomagnesemia and symptomatic. Mg deficiency . The various disease states. Table 1. The diagnosis of Mg deficiency is not easy since blood level. Mg does not always reflect the state of body Mg, and it may be. Mg depletion . Moreover, hypermagnesemia. Mg. depletion . The concentration of Mg in. Mg content of muscle, body exchangeable Mg and Mg. Mg. deficiency. These methods are either difficult to perform or do. The fate. of intravenous load of Mg may help in the diagnosis of Mg. Normal subjects excrete. Mg within 2. 4 to 4. Mg deficiency may retain more than 2. Mg. Therefore, the retention of an. Mg is consistent with Mg deficiency. Mg . This test is valid only when renal function is normal and. Mg depletion is not due to the inability of the kidney to. Mg. Protein- calorie malnutrition. Prolonged intravenous therapy. II. Decreased intestinal. Malabsorption syndromes including nontropical sprue. Massive surgical resection of small intestine. Neonatal hypomagnesemia with selective malabsorption of. III. Excessive losses of body fluids. Prolonged nasogastric suction. Excessive uses of purgatives. Intestinal and biliary fistulas. Severe diarrhea as in ulcerative colitis and infantile. Rarely, prolonged lactation. IV. Excessive urinary losses. Diuretic phase of acute renal failure. Primary aldosteronism. Hypercalcemic states: malignancy, hyperparathyroidism. D excess. 6. Renal tubular acidosis. Diabetes, especially during and following treatment of. Idiopathic renal magnesium wasting. Chronic renal failure with renal magnesium wasting. Idiopathic hypomagnesemia. Porphyria with inappropriate secretion of antidiuretic. Multiple transfusions or exchange transfusions with. Clinical manifestations and. Clinical. manifestations. Anorexia, nausea, weakness, and apathy. Muscular fibrillation. Tremors. Ataxia. Vertigo. Carpopedal spasms. Frank tetany Hyperreflexia - occasionally hyporeflexia. Depression. Irritability. Psychotic behavior. Laboratory findings. Hypomagnesemia, Hypocalcemia, Hypokalemia. Hypophosphatemia - occasionally hyperphosphatemia. Low urinary Mg and calcium. Low Mg in cerebrospinal fluid. Low Mg in muscle. Electrocardiogram may show. Prolongation of QTb) Broadening and decreased amplitude of T wavesc) Occasional shortening of ST segment. Electromyogram may show myopathic like potentials. The signs and symptoms of Mg depletion are. The studies. of Shills . The main clinical. Mg depletion include neuromuscular disturbances. These, as well as the laboratory. Table 2. Magnesium deficiency is managed by replacement with Mg salts. A. deficit of 1 to 2 m. Eq per kilogram body weight may exist in the. Magnesium sulphate. Mg. SO4,7. H2. O) is usually used for the. The molecular weight of this hydrated. Eq of. Mg. Repletion can be achieved either by intramuscular or. Mg. Usually about 4. In patients with normal renal. Eq of Mg may be given intravenously over 4 to 6. Eq per 1. 2. hours, or 1. Eq may be given intramuscularly every 2 to 4 hours. Frequent measurement of serum Mg. The dosage of Mg. Mg is mandatory in these. Finally, attempts should be made to identify the underlying. Also, efforts should be undertaken. Mg depletion in any clinical setting which may. For example, in patients who. Eq of. magnesium could prevent magnesium depletion. Magnesium homeostasis, parathyroid glands, and blood. Hypermagnesemia suppresses the activity of the parathyroid. The data on the. effect of hypomagnesemia are variable. Anast and coworkers. A similar finding was reported by. Chase and Slatopolsky . In addition studies by Targovnik et. These findings. are not necessarily inconsistent with data showing that acute. Mg in blood perfusing the. Chronic hypomagnesemia may have a. There is also. evidence that parathyroid gland activity may be normal or. Mg deficiency. However, even when blood levels of parathyroid. Mg depletion, they may not represent. Recent observations by Anast and co- workers . They found that blood levels of the hormone increased. Mg. These. observations are consistent with in vitro studies showing that. Mg concentration in the incubation media diminishes the. Relative or complete failure of the. Hypermagnesemia. Elevated levels of plasma Mg are seen in patients with acute. Hypermagnesemia may also be present in patients with. The signs and symptoms. Deep tendon. reflexes are usually lost when blood Mg exceeds 6 m. Eq/l. The administration of. Eq (1. 00- 2. 00 mg) of calcium ion may be adequate to reverse. On occasion, peritoneal or even hemodialysis may. In patients who. had respiratory paralysis, artificial respiration should be used. Mg is lowered. Magnesium metabolism in renal failure. Renal failure may be associated with disturbances in several. Mg metabolism. These include the renal handling of Mg. Renal handling of magnesium in renal failure. The daily urinary excretion of Mg is usually reduced in. Randall et al. In fifty patients with creatinine clearance. Mg per 2. 4 hours ranged between 1. Only two- thirds of. Mg . In patients with uremia and salt. Mg may be normal or high . Popovtzer et al. It is important to. Mg in view of. the renal handling of sodium, since the tubular reabsorption of. Massry et. al. Indeed, there is a positive and significant. Mg excreted and that. A similar relationship was observed in. As. indicated earlier, tubular reabsorption of Mg exhibits a Tm. In. renal failure filtered Mg per nephron is augmented secondary to. Under these circumstances, filtered Mg may exceed Tm. Mg and the fraction of filtered Mg excreted is increased. Other. factors may also be operative in advanced renal failure. Recent. studies have shown that uremic serum contains a humoral factor. Such a factor may be partly responsible for the augmented. Mg in the late stages of renal. We have evaluated renal handling of Mg during the diuretic. The fraction of. filtered Mg excreted is increased, and there is a positive and. Serum magnesium in renal failurea) Acute renal failure: The effect of acute renal. Mg was studied by Massry et. Hypermagnesemia was present in all but. The highest values noted. The magnesium concentration in serum was normal. The diffusible levels of serum Mg were also. The percent of serum Mg which. Abrupt increases in serum Mg can occur when the patients. Mg containing antacids or laxatives . It is known that Mg readily crosses the dialysis. Mg in blood and the concentration of. Mg in dialyzate . The importance of dialyzate Mg. Mg concentrations is. Mg and the other 1. Mg. level ranged from 1. Similar. observations were found by others . Whether chronic hypermagnesemia, such. Tissue content of magnesium in renal failurea) Red blood cells (RBC): The content of Mg in the. RBC of uremic patients undergoing treatment with hemodialysis is. We have evaluated the Mg. Mg in concentrations of either 1. Although there was an overlap between the individual. Mg was significantly higher (P. On the other hand, Contiguglia et al. These. observations were confirmed later by Berlyne et al. One is rapidly exchangeable and. The other is a. non- exchangeable pool. In patients with uremia, the excess. The most probable. Intestinal absorption of magnesium in renal. There are not adequate data on intestinal absorption of Mg in. The information available is on. Mg obtained from balance. Kopple. and Coburn . Evaluation of the available data indicate that net magnesium. Thus, it appears that chronic. In. contrast, Brannan et al. The reason for. the difference between the results of these acute studies and. Reprint. requests to Dr. Massry. Chief, Division of Nephrology, USC School of Medicine. Zonal Avenue, Los Angeles, CA. C., Miller N.: Bone magnesium pools in uremia. Anast C. W.: Evidence. Science 1. 77. 6. Anast C. W.. Impaired release of parathyroid hormone in magnesium deficiency. Balint J. I.: Hypomagnesemia with tetany in. L.: Hypomagnesemic. Barnes B. A., Cope O., Harrison T.: Magnesium conservation in. Berlyne G. M., Ben- Ari J., Szwarcberg J., Kaneti J., Danovitch. G. M., Kaye M.: Increase in bone magnesium content in renal. Nephron 9, 9. 0, 1. Blomfield J., Wilkinson C, Stewart J. C: Control of the hypermagnesemia of renal failure by. C., Bahouris N., Hanna S., Mac. Intyre I.: Incidence of. Bourgoignie J. H., Espinel C, Klahr S., Bricker. N. S.: A natriuretic factor in the serum of patients with chronic. Brady J. C: Magnesium intoxication in a. Brannan P. G., Vergne- Marini P., Pak C Y. S.: Magnesium absorption in the human small. Results in normal subjects, patients with chronic. Bricker N. S., Klahr S., Rieselbach R. E.: The functional.
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