Magnesium

Assignment
 Magnesium
- Magnesium is an essential element in biological systems, occurs typically
as the Mg2+ ion.
- Magnesium is the fourth most abundant mineral in the body and is the
second-most abundant intracellular cation, it is essential to good health.
- Approximately 50% of total body magnesium is found in bone. The other
half is found predominantly inside cells of body tissues and organs.
- Only 1% of magnesium is found in blood, but the body works very hard to
keep blood levels of magnesium constant.

- Green vegetables such as spinach are good

sources of magnesium, Some legumes (beans
and peas), nuts and seeds, and whole,
unrefined grains are also good sources of
magnesium and “Tap water” or “hard water”
can be a source of magnesium.
 Magnesium
ü300 enzyme systems are magnesium
activated.
üMost aspects of intracellular
biochemistry are magnesium dependent,
including glycolysis, oxidative metabolism
and transmembrane transport of potassium
and calcium.
üThe electrical properties of cell
membranes are affected by any reduction
in the intracellular magnesium
concentration.
Examples of the Physiological Role of Magnesium
 Functions
- It is an essential mineral nutrient for life and is present in every
cell type in every organism. For example, ATP must be bound to a
magnesium ion in order to be biologically active. ATP is often
actually Mg-ATP.
- Similarly, magnesium plays a role in the stability of all
polyphosphate compounds in the cells, including those associated
with DNA and RNA synthesis.
- It helps maintain normal muscle and nerve function, keeps heart
rhythm steady, supports a healthy immune system, and keeps
bones strong.
- Magnesium also helps regulate blood sugar levels, promotes
normal blood pressure, and is known to be involved in energy
metabolism and protein synthesis.
ü Magnesium influences the secretion of PTH by the parathyroid
glands and severe hypomagnesaemia may cause hypoparathyroidism.

Magnesium homeostasis
üSince magnesium is an integral part of chlorophyll green vegetables
are an important dietary source, as are cereals and animal meats. An
average dietary intake is around 15mmol per day which generally
meets the recommended dietary intake.
üChildren and pregnant or lactating women have higher
requirements.
üAbout 30% of the dietary magnesium is absorbed from the small
intestine and widely distributed to all metabolically active tissue.
üHypermagnesaemia is uncommon but is occasionally seen in renal
failure.
üThe symptoms of hypomagnesaemia are very similar to those of
hypocalcacmia: impaired neuromuscular function such as tetany,
hyperirritability, tremor, convulsions and muscle weakness.
• The serum levels of parathyroid hormone and magnesium depend
on each other in a complex manner.

• The secretion of parathyroid hormone by the parathyroid is

physiologically controlled by the serum calcium level, but
magnesium can exert similar effects.

• While low levels of magnesium stimulate parathyroid hormone

secretion, very low serum concentrations induce a paradoxical
block.
• This block leads to clinically relevant hypocalcemia in severely
hypomagnesiemic patients.

• The mechanism of this effect has recently been traced to an

activation of the alpha-subunits of heterotrimeric G-proteins.
• This activation mimicks activation of the calcium sensing receptor
and thus causes inhibition of parathyroid hormone secretion.
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• In addition to the effects of magnesium on
parathyroid hormone secretion, parathyroid
hormone in turn regulates magnesium
homeostasis by modulating renal
magnesium reabsorption.

• The distal convoluted tubule is of crucial

importance for parathyroid hormone-
regulated magnesium homeostasis
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MAGNESIUM
IMBALANCE
 DEFINITION
• Hypomagnesemia is serum magnesium concentration < 1.8
mg/dL (< 0.70 mmol/L). Causes include inadequate magnesium
intake and absorption or increased excretion due to
hypercalcemia or medications such as furosemide. Clinical
features are often due to accompanying hypokalemia and
hypocalcemia and include lethargy, tremor, tetany, seizures, and
arrhythmias. Treatment is with magnesium replacement.
 Magnesium Deficiency
ü Since magnesium is present in most common foodstuffs, low
dietary intakes of magnesium is associated with general
nutritional insufficiency.
ü Magnesium deficiency can be expected as a result of:
1. Dietary insufficiency accompanied by intestinal
malabsorption, severe vomiting, diarrhea or other causes of
intestinal loss.
2. Osmotic diuresis such as occurs in diabetes mellitus.
3. Prolonged use of diuretic therapy especially when dietary
intake has been marginal prolonged.
4. Nasogastric suction.
5. Cytotoxic drug therapy such as cisplatinum which impairs
renal tubular reabsorption of magnesium
6. Treatment with the immunosuppressant drug; cyclosporin.
CAUSES
 SYMPTOMS
Early signs of low magnesium include:
• nausea
• vomiting
• weakness
• decreased appetite
As magnesium deficiency worsens, symptoms may
include:
• numbness
• tingling
• muscle cramps
• seizures
• muscle spasticity
• personality changes
• abnormal heart rhythms
MANAGEMENT
 Renal Loss
Causes of Magnesium Deficiency:
Gastrointestinal Disorders
Manifestations of Magnesium Depletion
Laboratory diagnosis
üMagnesium concentration of less than 0.7 mmo1/L in a
serum specimen is evidence of marked intracellular
depletion. However, intracellular magnesium depletion may
exist where the serum magnesium concentration is within
the reference range.
Management
üOral, IM and IV regimens have been proposed.
üAdministration of magnesium salts, by whatever route is
contraindicated when there is a significant degree of renal
impairment. In these circumstances any supplementation
must be monitored carefully to avoid toxic effects associated
with hypermagnesaemia.
 DEFINITION
•Hypermagnesemia is an electrolyte disorder in
which there is a high level of magnesium in the
blood.
•Hypermagnesemia is a serum magnesium
concentration > 2.6 mg/dL (> 1.05 mmol/L)
 CAUSES
• Most cases of hypermagnesemia occur in people who
have kidney failure. Hypermagnesemia occurs because
the process that keeps the levels of magnesium in the
body at normal levels does not work properly in people
with kidney dysfunction and end-stage liver disease.
• Other causes of hypermagnesemia include:
• lithium therapy
• hypothyroidism
• Addison’s disease
• milk-alkali syndrome
• drugs containing magnesium, such as some
laxatives and antacids
• familial hypocalciuric hypercalcemia
 SYMPTOMS
• nausea
• vomiting
• neurological impairment
• abnormally low blood pressure (hypotension)
• flushing
• headache
 MANAGEMENT
• The first step in treating hypermagnesemia is
identifying and stopping the source of extra
magnesium
• An intravenous (IV) calcium supply is then used to
reduce symptoms such as impaired breathing,
irregular heartbeat, and hypotension, as well as
the neurological impact.
• Intravenous calcium, diuretics, or water pills may
also be used to help the body get rid of excess
magnesium.
• People with renal dysfunction or those who have
had a severe magnesium overdose may require
dialysis if they are experiencing kidney failure, or
if magnesium levels are still rising after
treatment.