Talk:Hypomagnesemia

Through the kidneys

The statement "About 2400 mg of magnesium passes through the kidneys" looks good to my limited knowledge, but requires a frequency (per day?) very best regards, sgsmith, new orleans 10-17-2007 72.204.154.35 15:46, 17 October 2007 (UTC)

nice work! Erich 12:38, 29 October 2005 (UTC)

I added "daily" to this on a guess. Let somebody with the facts correct it and discuss it. It's been too long.

Definition of hypomagnesemia

I changed the definition of hypomagnesemia back again to low blood levels rather than total body magnesium. The word hypomagnesemia literally means low blood levels of magnesium. This can be indicative of total body magnesium depletion, but that doesn't change the definition. At least three medical dictionaries I consulted seem to agree on this definition. Also, most symptoms (neuromuscular and cardiovascular) are caused by a decreased level of magnesium in the blood, not a decreased amount of magnesium in the whole body. --WS 13:39, 29 October 2005 (UTC)

Technically you are correct, the word refers to bloodlevels. Yet practically magnesium bloodlevels are not related to symptoms (neurological effects are not the primary symptoms), nor even a lack of magnesium (deficiency). Please read the article as to why. Since hypomagnesemia is usually symptomatic as result of total body levels, I would prefer that to be included in the definition.--Nomen Nescio 15:13, 29 October 2005 (UTC)

Even if the symptoms are not directly related, that doesn't change the definition. Of course things can be explained later on, but you can't just change the definition of a word because you don't like it. (If you really want another definition, start the article total body magnesium depletion or something similar) --WS 15:37, 29 October 2005 (UTC)

Or probably better: Magnesium deficiency (medicine) (ICD10 code: E61.2). --WS 16:21, 29 October 2005 (UTC)

I agree with WS, and I've created a stub article at the subject he's suggested. But I do think that in the articles we should acknowledge that in many contexts the terms are used interchangably, even if there is a subtle distinction between them. --Arcadian 18:10, 29 October 2005 (UTC)

I agree we should adhere to the literal meaning. However, in the new stub it is suggested hypomagnesemia is lack of magnesium. My point is just that this is wrong. Hypomagnesemia can be present without magnesium deficiency and vice versa. Therefore they are not the same. Hypomagnesemia has no clinical significance, for practical reasons we use bloodlevels, but this is inherently subject to incorrect interpretation (see article). This should also be reflected by the new article. --Nomen Nescio 19:10, 29 October 2005 (UTC)

Would you mind fleshing Magnesium deficiency (medicine) out a bit to reflect that? --Arcadian 19:34, 29 October 2005 (UTC)

Need Clarification on the Effect of Hypomagnesemia on PTH

The article states, "Lack of magnesium inhibits the release of parathyroid hormone, which can result in hypoparathyroidism and hypocalcemia. Furthermore, IT makes skeletal and muscle receptors less sensitive to parathyroid hormone." [allcaps added for emphasis]

Questions:

1. Does "it" mean "magnesium" or "lack of magnesium?"

2. If "it" means "magnesium," then this implies opposing effects of low magnesium. What is the net effect: increased PTH activity (reduced PTH level, but an outweighing increase in PTH sensitivity) or reduced PTH activity (an increase in PTH sensitivity, but an outweighing reduction PTH level)?

An answer to these questions that includes reference to an online medical research or review article would be appreciated.

Leeirons (talk) 18:13, 11 December 2007 (UTC)

Hypomagnesaemia inhibits PTH release and causes resistance to what PTH there is. Review article: http://jasn.asnjournals.org/content/20/11/2291.full Arripay (talk) 21:04, 22 October 2013 (UTC)

Apologies, have just seen that this has already been addressed in the article. Arripay (talk) 21:40, 22 October 2013 (UTC)

Some questions about when your heart "skips a beat"

Following a few instances of "skipped heartbeats" in a brief period 20 years ago (after receiving no diagnosis of trouble nor suggestion for improvement from a physician) I hit upon the remedy of taking magnesium from a Usenet enthusiast, which I've done in the form of Epsom salt in well under the recommended laxative dose - at first after skipped beats, but eventually in response to the sensation of weariness in the heart or other muscles to prevent the skipped beats from happening. Mind, I never had the problem much and have gone a long time without having one at all now, but since the body's response to one is a massive injection of adrenaline they tend to stand out. I haven't found much documentation for or against a few things I've noticed.

• Does ham or other processed meat reduce serum magnesium? I eventually tracked down that the "skipped beats" seemed to follow consuming large amounts of preserved meat almost exclusively, but not other salty food. It's gotten to the point that if I dig deep into a holiday ham I take the Epsom salt as an "antidote" right afterward. On the other hand, healthy eating with lots of fruits and vegetables seems to prevent the need for this.

• Can serum magnesium be determined by taste? I haven't been doing lab tests, but I've noticed that sometimes when I think I'm in need of it, Epsom salt can taste literally as sweet as sugar, while at other times it can be intensely bitter.

• Do skipped heartbeats reflect fatigue? As mentioned above, I feel as if that is the case - that the heart can "stumble" like a tired runner to cause a missed beat.

• What does a normal missed beat look like on an EKG? Is it like one lone torsades de pointes in the middle of a normal pattern, or a flat line, or a single peak with reduced intensity?

• An underlying reason for my interest is that I tend to think that cardiovascular disease, being very common in the population, should not come unannounced - that rare and "normal" abnormalities like a skipped beat could be harbingers of future problems. Is there any sense to that way of thinking? 70.15.116.59 (talk) 21:27, 9 January 2008 (UTC)

diuretics

it should probably be clarified that hypomagnesemia from diuretic use is from loop diuretics. magnesium is not resorbed in the collecting tubule, for instance, so K-sparing diuretics should not cause hypomagnesemia... 71.234.109.192 (talk) 00:55, 13 January 2008 (UTC)

correction

"Hypomagnesemia results in increased efflux of intracellular Mg" should be changed as "Hypomagnesemia results in increased efflux of intracellular K". So i changed it. —Preceding unsigned comment added by Sinharaja2002 (talk • contribs) 12:58, 15 October 2008 (UTC)

Staggers

In cows, there are two types of hypomagnesemia - why does this article focus entirely on humans? Maybe an expert in veterinary medicine could help here. I know it colloquially as 'the staggers' and know it has relevance to BSE, as it was firstly misdiagnosed before 1986. —Preceding unsigned comment added by 78.105.61.252 (talk) 02:15, 15 January 2009 (UTC)

Addition

I would like to add the following discussion at an appropriate point:

"Hypomagnesemia is a potentially life threatening problem if not handled promptly and properly. The patient will exhibit tremors and tetany at the beginning but this may not be visible if they are bedridden and only receiving casual monitoring. As the deficiency becomes more severe, they will appear to fall into a coma and become unresponsive. Very soon after this, the heart will lose power in the left ventricle. This will cause a pressure difference across the lungs. Fluid will burst into the lungs and the patient will not be able to breath. The damage from this is irreversible and death will follow shortly after. The cause of death for these patients is almost always listed as heart failure. But a closer review of the patient's history would reveal that this is not the root cause - the root cause is hypomagnesemia."

Does this addition need to be approved by someone or do I just put it in ? Bluesky2013 (talk) 00:10, 3 October 2013 (UTC)bluesky — Preceding unsigned comment added by Bluesky2013 (talk • contribs)

paragraph removed Bluesky2013 (talk) 18:12, 16 October 2013 (UTC)bluesky2013

Do you have a reliable source for this information? Read WP:Verifiability, WP:Identifying reliable sources and WP:MEDRS. The second part is nlikely to be acceptable, because Wikipedia does not give medical advice. JohnCD (talk) 19:08, 16 October 2013 (UTC)

I'm rather skeptical. The first part claims, for example, that there's a comparatively vast number of misdiagnosed deaths due to hypomagnesemia - that would likely require some very carefully designed, large-scale studies to detect, or it's pure original research and guesswork. The second part is worse and in the end turns into a how-to guide. Huon (talk) 21:00, 16 October 2013 (UTC)

discussion is ongoing, there is no need for a help me template here

Thanks for responding.

I have removed the second paragraph so we can focus on the first.

Let me respond to your points:

First there is nothing in the first paragraph (or the second either) that talks about the frequency of occurrence of hypomagnesemia in elderly patients. I don't know what the frequency is. I have seen it only one time. When I discussed it with the head nurse at the facility, she said it was fairly common but she did not have any statistics. I have searched for statistics on-line and I can only find statistics on annual deaths from chronic and acute heart failure as a total. Chronic heart failure is totally different and not part of this discussion.

You would like me to provide a reference. I have not found anything that summarizes the impact of hypomagnesemia exactly as I have done here. If I could, I would not need to write this paragraph. However, all this paragraph does is restate clearly and concisely what happens, there is nothing new in it. Let me step through it line by line

Hypomagnesemia is a potentially life threatening problem if not handled promptly and properly.

It is common knowledge that muscles do not work if they do not have enough electrolytes. This includes the heart. If the heart stops the person dies. So the reference for this is any textbook on human physiology.

The patient will exhibit tremors and tetany at the beginning but this may not be visible if they are bedridden and only receiving casual monitoring.

The reference for this is your article. It is well known that a patient will experience tremors and tetany in the early stages of hypomagnesemia.

As the deficiency becomes more severe, they will appear to fall into a coma and become unresponsive.

The reference for this is also your article. It does not use the word coma but that is the best word to describe what I saw. The words it does use are close enough.

Very soon after this, the heart will lose power in the left ventricle.

This might not be so obvious. But there are only 2 ways the heart can fail due to electrolyte imbalance. Either the entire organ shuts down or a part of it shuts down. If the entire organ shuts down (ie it stops beating), the patient will die from lack of oxygen. Some cases of death from hypomagnesemia may occur this way. I only saw one case. In that case, the person's lungs filled with fluid and he could not breath. So I need to expain how this occurs as part of this writeup. The second way the heart can fail is if only a part of it fails. There are 2 main parts: the left ventricle and the right ventricle. The other chambers are subordinate. The left ventricle has to push blood out into the entire body. This requires a lot of energy. The right ventricle only has to push blood into the lungs. If there is a shortage of electrolytes, the ventricle that needs the most energy is going to fail first most of the time. That is the left ventricle. Also, if the right ventricle failed first, blood flow into the lungs would stop and you would not see the lungs full of fluid as the person died. I don't have a reference for this but it looks like common sense to me. I will try to find a reference.

This will cause a pressure difference across the lungs.

The patient is at a point where the right ventricle is still pumping at a reasonable level but the left ventricle is weakened because of insufficient electrolytes. Fluid (ie blood) is incompressible. The amount of fluid pushed into the lungs must exactly equal the amount of fluid being pulled out of them. If this is not the case, there is a pressure difference. The reference for this is any fluid dynamics textbook.

Fluid will burst into the lungs and the patient will not be able to breath.

The pressure must be relieved somehow unless the container is strong enough to contain it. The lungs are very delicate and not able to withstand any significant internal pressure so they burst. The reference for this is any fluid dymanics textbook.

The damage from this is irreversible and death will follow shortly after.

Once the lungs are blown out, the patient cannot intake sufficient oxygen. They are going to die from lack of oxygen and/or loss of blood. That this damage is irreversible I think is obvious.

The cause of death for these patients is almost always listed as heart failure.

The top level cause of death in these cases is acute heart failure. But this is not the root cause. When I searched the internet to find root causes of acute heart failure, I could find only 2 - a blood clot and an extreme electrolyte imbalance. In my example case, the facility took an XRay to rule out a blood clot. I believe there is no requirement currently to list the root cause of death on the death certificate so it going to list heart failure as the cause of death. Given that, there will be no statistics on death by hypomagnesemia.

But a closer review of the patient's history would reveal that this is not the root cause - the root cause is hypomagnesemia.

My purpose in writing this paragraph is to indicate that death from hypomagnesemia is possible. And if it occurs, how it would look to an observer. I think this paragraph accomplishes this. I will attempt to find some more specific references. And I am willing to work with you to get this into an acceptable final form.

Bluesky2013 (talk) 01:14, 21 October 2013 (UTC)

The problem is that you are presenting something new by pulling together material from existing articles, from textbooks and from your own experience; but that falls under Wikipedia's definition of original research, specifically the section WP:SYNTH: "Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources." JohnCD (talk) 13:47, 21 October 2013 (UTC)