Boron
and Calcium and Magnesium
References:
Environ Health Perspect. 1994 Nov;102 Suppl
7:79-82.
Effects of boron supplementation on bone mineral
density and dietary, blood, and urinary calcium, phosphorus,
magnesium, and boron in female athletes.
Meacham SL, Taper LJ, Volpe SL.
Department of Human Nutrition, Winthrop University, Rock
Hill, South Carolina 29733.
The effects of boron supplementation on blood and urinary
minerals were studied in female college students--17 athletes
and 11 sedentary controls--over a one-year period. The
athletes had lower percent body fat and higher aerobic
capacities than sedentary controls. Athletic
subjects consumed more boron in their normal diets than
sedentary subjects; all other dietary measures were similar
between the two groups. The
athletes showed a slight increase in bone mineral density,
whereas the sedentary group showed a slight decrease.
Serum phosphorus concentrations were lower in boron-supplemented
subjects than in subjects receiving placebos, and were
lower at the end of the study period than during baseline
analysis. Activity depressed changes in serum phosphorus
in boron-supplemented subjects. Serum magnesium concentrations
were greatest in the sedentary controls whose diets were
supplemented with boron, and increased with time in all
subjects. A group x supplement interaction was observed
with serum magnesium; exercise in boron-supplemented subjects
lowered serum magnesium. In all subjects, calcium excretion
increased over time; in boron-supplemented subjects, boron
excretion increased over time. In all subjects, boron supplementation
affected serum phosphorus and magnesium, and the excretion
of urinary boron. ↑ Back To Top
Biol Trace Elem Res. 1992 Dec;35(3):225-37.
Studies of the interaction between boron and calcium,
and its modification by magnesium and potassium, in rats.
Effects on growth, blood variables, and bone mineral composition.
Nielsen FH, Shuler TR.
United States Department of Agriculture, Grand Forks Human
Nutrition Research Center, ND 58202-7166.
Two experiments were performed to confirm that boron interacts
with calcium, and that this interaction can be modified
by dietary magnesium and potassium in the rat. Upon manipulating
the dietary variables listed above, it
was found that under certain conditions, boron and calcium
deprivation similarly affected several variables; for example,
they both could be made to elevate plasma alkaline phosphatase
activity and to depress femur calcium concentration. Under
some dietary conditions, both boron and calcium deprivation
affected some variables related to blood or iron metabolism.
However, the effects of dietary boron and calcium on spleen
weight/body weight ratio, hematocrit, and femur iron concentration
generally were not similar. Femur copper, magnesium, phosphorus,
and zinc also were affected by an interaction between boron
and calcium under some dietary conditions. The findings
show that there is a relationship between boron and calcium,
but they do not clearly indicate the nature of the relationship.
However, the data suggest that boron and calcium act on
similar systems in the rat. ↑ Back To Top
Magnes Trace Elem. 1991-92;10(5-6):387-408.
Effects of dietary boron on calcium and mineral
metabolism in the streptozotocin-injected, vitamin D3-deprived
rat.
Hunt CD, Herbel JL.
USDA, Grand Forks Human Nutrition Research Center, N. Dak.
Dietary boron, in concentrations similar to that found
in human diets comprised mainly of fruits and vegetables,
affects both mineral and energy metabolism. Therefore,
the effects of boron on a model system with a perturbed
metabolic insulin-vitamin D3 axis was examined. Weanling
male rats were fed a ground corn-high protein casein-corn
oil-based diet (0.06 mg B/kg; no supplemental vitamin D3)
supplemented with B (as orthoboric acid) at 0 or 2.4 mg/kg.
After 55 days, all rats were equilibrated in individual
metabolic cages for 6 days. After another 6 days, one half
of the rats in both dietary groups were injected intraperitoneally
with streptozotocin (STZ). All rats were killed 3 days
after STZ treatment. STZ affected many aspects of mineral
metabolism as expected. Plasma ionized calcium concentrations
fell by approximately 10% in STZ-treated rats. Brain and
heart mineral metabolism was spared from the toxic effects
of STZ whereas spleen mineral metabolism was especially
vulnerable to STZ. Supplemental dietary boron increased
urinary excretion of calcium in the non-STZ rats but did
not affect the plasma concentrations of alkaline phosphatase,
ionized calcium or the concentration of calcium in the
brains, lungs, kidneys and spleens of those animals. Supplemental
dietary boron temporarily reduced the abnormally elevated
renal excretion of albumin, potassium and sodium during
the acute phase of diabetes mellitus. On the other
hand, physiological amounts of dietary boron exacerbated
the abnormally elevated rate of collagen breakdown in the
STZ animal. Finally, boron may have indirectly affected
heart mineral metabolism because dietary boron did not
affect cardiac boron concentrations but did affect cardiac
copper, calcium, manganese, molybdenum and phosphorus concentrations,
primarily in non-STZ rats. The
findings suggest that dietary boron has both protective
and regulatory roles in mineral metabolism. ↑ Back To Top
MAGNESIUM
Magnes Res. 2004 Sep;17(3):197-210.
The alteration
of magnesium, calcium and phosphorus metabolism by dietary
magnesium deprivation in postmenopausal women is
not affected by dietary boron deprivation.
Nielsen FH.
USDA, Agricultural Research Service, Grand Forks Human
Nutrition Research Center, Grand Forks, ND, 58202-9034,
USA.
A study with human volunteers was conducted to test the
hypothesis that naturally occurring inadequate intakes
of magnesium induce negative magnesium balance and undesirable
changes in calcium metabolism variables, and that these
changes are influenced by dietary boron. Diets composed
of ordinary Western foods providing approximately 118 and
318 mg Mg/d and approximately 0.25 and 3.25 mg B/d were
fed in a double-blind Latin square design to 13 healthy,
post menopausal Caucasian women (aged 50-78 years) living
in a metabolic unit. Magnesium balance, which was positive
when dietary magnesium was 318 mg/d, became negative when
dietary magnesium was 118 mg/d. Magnesium
deprivation decreased urinary calcium excretion, and significantly
increased calcium balance when balance data analyzed
came from all collections during the 42-day periods. Urinary
phosphorus excretion was increased, but fecal phosphorus
excretion was decreased, thus phosphorus balance was not
significantly affected by magnesium deprivation. Magnesium
deprivation did not affect manganese or zinc balance. The
balance data indicated that 700 mg of calcium, 1.0 mg of
manganese, and 10 mg of zinc were adequate for post menopausal
women. Magnesium
deprivation increased serum 25-hydroxycholecalciferol and
decreased serum total cholesterol concentrations. Boron
deprivation increased but magnesium deprivation
decreased urinary potassium excretion. Boron supplementation
decreased serum 17beta-estradiol and progesterone when
dietary magnesium was low. The dietary treatments did not
affect serum calcitonin, parathyroid hormone, osteocalcin
or alkaline phosphatase concentrations. One woman placed
on consecutive magnesium-low dietary periods exhibited
heart ventricular ectopy after consuming the magnesium-low
diet for 72 days; the ectopy disappeared upon consuming
the magnesium-adequate diet. The
findings indicated that consuming an ordinary diet deficient
in magnesium, resulting in negative magnesium balance,
can affect calcium, potassium, and cholesterol metabolism.
Dietary boron did not have an obvious effect on the response
to magnesium deprivation. ↑ Back To Top
West J Med. 1990 Feb;152(2):145-8.
Low intracellular magnesium in patients with acute
pancreatitis and hypocalcemia.
Ryzen E, Rude RK.
Department of Medicine, Los Angeles County-University of
Southern California Medical Center.
To determine the role of magnesium deficiency in the pathogenesis
of hypocalcemia in acute pancreatitis, we measured magnesium
levels in serum and in peripheral blood mononuclear cells
in 29 patients with acute pancreatitis, 14 of whom had
hypocalcemia and 15 of whom had normal calcium levels.
Only six patients had overt hypomagnesemia (serum magnesium < 0.70
mmol per liter [I. 7 mg per dl]). The mean serum magnesium
concentration in hypocalcemic patients was not significantly
lower than in normocalcemic patients, but the mononuclear
cell magnesium content in hypocalcemic patients with pancreatitis
was significantly lower than in normocalcemic patients
with pancreatitis (P < .Of). The serum magnesium level
did not correlate with that of serum calcium or the mononuclear
cell magnesium content, but the latter did significantly
correlate with the serum calcium concentration (r = .8l,
P < .001). Most patients with hypocalcemia had a low
intracellular magnesium content. Three normomagnesemic,
hypocalcemic patients with alcoholic pancreatitis also
underwent low-dose parenteral magnesium tolerance testing
and showed increased retention of the magnesium load. We
conclude that patients with acute pancreatitis and hypocalcemia
commonly have magnesium deficiency despite normal serum
magnesium concentrations. Magnesium
deficiency may play a significant role in the pathogenesis
of hypocalcemia in patients with acute pancreatitis. ↑ Back To Top
J Am Coll Nutr. 1990 Apr;9(2):114-9.
Effect of intravenous epinephrine on serum magnesium
and free intracellular red blood cell magnesium concentrations
measured by nuclear magnetic resonance.
Ryzen E, Servis KL, Rude
RK.
Department of Internal Medicine, University of Southern
California, Los Angeles.
Hypomagnesemia
is a common clinical finding in hospitalized patients and
can cause hypocalcemia, cardiac arrhythmias, muscular weakness,
and hypokalemia. Hypomagnesemia usually implies
cellular magnesium (Mg) depletion, but stress and some
clinical conditions which raise serum catecholamine concentrations
may lower serum Mg (sMg) concentrations. To help investigate
the mechanism and degree of the effect of catecholamines
on sMg concentration, we gave intravenous epinephrine (0.1
microgram/kg/min) to 12 normal volunteers for 2 hours.
The sMg concentration fell from 1.86 +/- 0.04 mg/dl to
1.63 +/- 0.05 mg/dl (mean +/- SEM, p less than 0.01). Pre-infusion
intracellular free Mg (Mg++) in red blood cells (RBC) as
measured by nuclear magnetic resonance spectrophotometry
(NMR) was 171 +/- 7.6 microM and did not differ significantly
from post-infusion RBC Mg++, 186 +/- 12.6 microM. Total
blood mononuclear cell Mg content and urine Mg excretion
also did not change. These data suggest that epinephrine
has a small but significant effect on the lowering of sMg
concentrations. Endogenous catecholamine release during
stress or acute illness may therefore contribute to the
hypomagnesemia seen in acutely ill patients. Our data also
suggest that hypomagnesemia seen under conditions of acute
stress may not always imply depleted tissue Mg stores.
As no absolute change in cellular Mg or in urinary Mg excretion
was demonstrated, acute intracellular shifts of Mg into
blood cells and/or urinary Mg losses may not account for
the hypomagnesemia. The prevalence and clinical consequences
of stress hypomagnesemia require further investigation. ↑ Back To Top
Eur J Clin Nutr. 2004 Feb;58(2):270-6. ---
Influence of a mineral water rich in calcium, magnesium
and bicarbonate on urine composition and the risk of calcium
oxalate crystallization.
Siener R, Jahnen A, Hesse A.
Division of Experimental Urology, Department of Urology,
University of Bonn, Bonn, Germany.
OBJECTIVE: To evaluate the effect of a mineral water rich
in magnesium (337 mg/l), calcium (232 mg/l) and bicarbonate
(3388 mg/l) on urine composition and the risk of calcium
oxalate crystallization. DESIGN: A total of 12 healthy
male volunteers participated in the study. During the baseline
phase, subjects collected two 24-h urine samples while
on their usual diet. Throughout the control and test phases,
lasting 5 days each, the subjects received a standardized
diet calculated according to the recommendations. During
the control phase, subjects consumed 1.4 l/day of a neutral
fruit tea, which was replaced by an equal volume of a mineral
water during the test phase. On the follow-up phase, subjects
continued to drink 1.4 l/day of the mineral water on their
usual diet and collected 24-h urine samples weekly. RESULTS:
During the intake of mineral water, urinary pH, magnesium
and citrate excretion increased significantly on both standardized
and normal dietary conditions. The mineral water led to
a significant increase in urinary calcium excretion only
on the standardized diet, and to a significantly higher
urinary volume and decreased supersaturation with calcium
oxalate only on the usual diet. CONCLUSIONS: The
magnesium and bicarbonate content of the mineral water
resulted in favorable changes in urinary pH, magnesium
and citrate excretion, inhibitors of calcium oxalate stone
formation, counterbalancing increased calcium excretion. Since
urinary oxalate excretion did not diminish, further studies
are necessary to evaluate whether the ingestion of calcium-rich
mineral water with, rather than between, meals may complex
oxalate in the gut thus limiting intestinal absorption
and urinary excretion of calcium and oxalate. ↑ Back To Top
J Intensive Care Med. 2005 Jan-Feb;20(1):3-17.
Magnesium deficiency in critical illness.
Tong GM, Rude RK.
University of Southern California,
School of Medicine, Los Angeles, CA 90089-9317, USA.
Magnesium (Mg) deficiency commonly occurs in critical illness
and correlates with a higher mortality and worse clinical
outcome in the intensive care unit (ICU). Magnesium
has been directly implicated in hypokalemia, hypocalcemia, tetany,
and dysrhythmia. Moreover, Mg may play a role in acute
coronary syndromes, acute cerebral ischemia, and asthma. Magnesium
regulates hundreds of enzyme systems. By regulating enzymes
controlling intracellular calcium, Mg affects smooth muscle
vasoconstriction, important to the underlying pathophysiology
of several critical illnesses. The principle causes
of Mg deficiency are gastrointestinal and renal losses;
however, the diagnosis is difficult to make because of
the limitations of serum Mg levels, the most common assessment
of Mg status. Magnesium tolerance testing and ionized Mg2+
are alternative laboratory assessments; however, each has
its own difficulties in the ICU setting. The use of Mg
therapy is supported by clinical trials in the treatment
of symptomatic hypomagnesemia and preeclampsia and is recommended
for torsade de pointes. Magnesium therapy is not supported
in the treatment of acute myocardial infarction and is
presently undergoing evaluation for the treatment of severe
asthma exacerbation, for the prevention of post-coronary
bypass grafting dysrhythmias, and as a neuroprotective
agent in acute cerebral ischemia ↑ Back To Top
Ann Acad Med Stetin. 1997;43:225-38.
[Behavior of selected bio-elements in women with
osteoporosis]
Kotkowiak L. [Article in Polish]
Z Zakladu Medycyny Rodzinnej Pomorskiej Akademii Medycznej
w Szczecinie, Szczecin.
The
purpose of this study was to evaluate the concentration
of calcium, magnesium, zinc and copper in serum, urine
and hair in women with osteoporosis, and to find
out whether deficiency of these bioelements correlates
with BMD. The concentration of calcium, magnesium, zinc
and copper was assessed in 80 women aged 40-68 years. The
women had been menopausal for 9.3 years and had never undergone
hormone replacement, drugs therapy or mineral supplementation.
The bone mass density (BMD) in lumbar spine L2-L4 was measured
in 80 postmenopausal women using dual energy X-ray absorptiometry.
According to BMD values all women were divided into two
groups. The first group (50 persons) comprised women with
osteoporosis. The second group included 30 women without
osteoporosis. After an overnight fasting the levels of
calcium, magnesium, zinc and copper in serum, in urine
and in hair were measured by AAS. Concentration of osteocalcin
and ionized calcium as well as magnesium was also measured
in serum. Calcium, magnesium, zinc and copper excretions
were expressed as a ratio of urinary creatine. Data were
compared with Wilcoxon-Mann-Whitney's test and significance
was assessed at p < 0.05. The regression and correlation
analysis was performed between BMD and level of bioelements.
It was determined that the
mean serum osteocalcin in the examined group (2.067 ng/ml)
was higher than in the control group (1.602 ng/ml).
It was also disclosed that there
was a lower level of total (Tab. 1) and ionized magnesium
in serum (Tab. 2) and reduced excretion of this
element in urine (Tab. 4) of fasting women with osteoporosis.
The concentrations of calcium, zinc and copper in serum
(Tab. 1) and in urine (Tab. 4) in both groups were similar
to laboratory normal range. Hair calcium and magnesium
levels in examined group were lower in comparison with
the control group (Tab. 3). Concentrations of zinc and
copper in hair were similar in both groups (Tab. 3). The
study found out that women with osteoporosis displayed
magnesium deficiency. The results showed that highly significant
correlation existed between magnesium and calcium.
No significant relationship between BMD and the concentration
of bioelements was observed. ↑ Back To Top
Intern Med. 2004 May;43(5):410-4.
Depressive state and paresthesia dramatically improved
by intravenous MgSO4 in Gitelman's syndrome.
Enya M, Kanoh Y, Mune
T, Ishizawa M, Sarui
H, Yamamoto M, Takeda
N, Yasuda K, Yasujima
M, Tsutaya S, Takeda
J.
Third Department of Internal
Medicine, Gifu University School of Medicine, 40 Tsukasa-machi,
Gifu 500-8705.
A 69-year-old woman was referred to our department for
evaluation of hypokalemia, which had been treated by oral
potassium for more than ten years. She complained of headache,
knee joint pain, sleeplessness and paresthesia in extremities
and, most prominently, depression. Laboratory data suggested Gitelman's
syndrome, which is caused by mutations in the gene
encoding the thiazide-sensitive Na-Cl cotransporter. Direct
sequencing of the gene in this patient revealed homozygous
mutation R964Q in exon 25. Intravenous
supplement of MgSO4 dramatically improved both the depression
and the paresthesia, suggesting that hypomagnesemia
played a role in the clinical manifestations. ↑ Back To Top
Arch Intern Med. 1988 Aug;148(8):1801-5.
The effect of intravenous magnesium therapy on
serum and urine levels of potassium, calcium, and sodium
in patients with ischemic heart disease, with and without
acute myocardial infarction.
Rasmussen HS, Cintin C, Aurup
P, Breum L, McNair P.
Medical Department P/Chest Clinic, Bispebjerg Hospital.
Serum concentrations of magnesium, potassium, calcium,
and sodium were determined on admission of 224 patients
to the hospital and after 2, 4, and 6 days in hospital;
all were admitted to the hospital with suspected acute
myocardial infarction (AMI). On admission, the patients
were randomly allocated to 48 hours of treatment with magnesium
intravenously or placebo. One hundred twenty-three patients
had AMI (of whom 53 [43%] were treated with magnesium)
and 101 had their suspected AMI disproven (of whom 51 [50%]
were treated with magnesium). In a supplementary study,
serum and urine levels of magnesium, potassium, calcium,
and sodium, together with serum levels of parathyroid hormone,
were determined before and after intravenous magnesium
treatment in six patients with AMI and six patients with
ischemic heart disease but without AMI. In both studies,
magnesium therapy was associated with significant alterations
in extracellular ion homeostasis. Serum
concentrations of potassium decreased during the
initial days of hospitalization in the patients treated
with placebo, but increased
slightly in the patients treated with magnesium infusions. These
increments in the serum concentrations of magnesium and
potassium correlated significantly. The increase in the
serum concentration of potassium after magnesium infusions
was due
to a reduced renal potassium excretion level (from
71.3 to 49.4 mmol/24 h), indicating the existence of a
divalent-monovalent cation exchange mechanism in the nephron.
This hypothesis was supported by the observation that renal
sodium excretion likewise decreased after magnesium infusions (from
83.2 to 59.2 mmol/24 h). Serum
concentration of calcium decreased significantly after
magnesium treatment (from 2.35 mmol/L on admission
to 2.15 mmol/L after 24 hours in the hospital) in the AMI
group, in contrast to the placebo-treated patients, where
no significant fluctuations in serum concentration of calcium
were detected during the initial six days. This decrease
in serum concentration of calcium was due
to a marked increase in renal calcium excretion (from
3.43 mmol/24 h before to 6.59 mmol/24 h after magnesium
infusion). A correlation between increments in serum magnesium
concentration and decrements in serum calcium concentration
was detected. No change in serum levels of parathyroid
hormone was found before and after magnesium infusions.
Both serum and urine levels of magnesium significantly
increased after magnesium treatment to levels above the
upper normal limits (serum magnesium concentration increased
from 0.81 to 1.21 mmol/L, urine magnesium excretion levels
from 3.57 to 16.57 mmol/24 h for both serum and urine changes. ↑ Back To Top
Clin Endocrinol (Oxf). 1976 May;5(3):209-24.
Functional hypoparathyroidism and parathyroid hormone
end-organ resistance in human magnesium deficiency.
Rude RK, Oldham SB, Singer
FR.
Hypocalcaemia
is a well-recognized manifestation of magnesium deficiency.
We have studied seventeen patients with this syndrome in
an attempt to determine the pathogenesis of the hypocalcaemia.
Mean initial serum calcium concentration was 5-6 mg/dl
and mean initial serum magnesium concentration was 0-75
mg/dl. Serum immunoreactive parathyroid hormone (IPTH)
was measured in sixteen patients in the untreated state.
Despite severe hypocalcaemia, serum IPTH was either undetectable
(less than 150 pg/ml) or normal (less than 550 pg/ml) in
all but two patients. Serial measurements made during the
initial 4 days of magnesium therapy in four patients showed
an increase in serum IPTH within 24h, but a delayed increase
in serum calcium, which required approximately 4 days to
reach normal values. The effect of the rapid normalization
of serum magnesium on serum IPTH and serum calcium concentration
was studied in three patients. Within 1 min after 144-300
mg of elemental magnesium was administered i.v., serum
IPTH had risen from undetectable to 3600 pg/ml and 1725
pg/ml in two patients and from 425 pg/ml to 937 pg/ml in
the third. Serum calcium concentrations were unchanged
after 30-60 min. These data provide evidence for impaired
parathyroid gland function in most of the magnesium deficient
patients. The rapidity with which serum IPTH rose in response
to magnesium therapy indicates that this may reflect a
defect in parathyroid hormone (PTH) secretion rather than
its biosynthesis. The failure of serum calcium concentration
to increase during the initial days of magnesium repletion,
at a time when serum IPTH concentrations were normal or
elevated, suggests end-organ resistance to PTH in these
patients. The renal response to PTH was examined in two
magnesium deficient patients by measurement of urinary
cyclic AMP excretion following administration of parathyroid
extract. In both patients there was a minimal increase
in urinary cyclic AMP concentrations. In contrast, when
the hepatic response to glucagon was tested on the same
patients by measurement of plasma cyclic AMP concentrations
following administration of glucagon, normal increases
were observed. These results suggest that adenylate cyclase
systems of various organs may be affected differentially
by a state of magnesium deficiency. It is suggested that
magnesium deficiency may result in defective cyclic AMP
generation in the parathyroid glands and in the PTH target
organs. This could be the principal mechanism operative
in both impaired PTH secretion and end-organ resistance ↑ Back To Top
J Clin Endocrinol Metab. 1969 Jun;29(6):842-8.
Hypocalcemia
due to hypomagnesemia and reversible parathyroid
hormone unresponsiveness.
Estep H, Shaw WA, Watlington
C, Hobe R, Holland W, Tucker
SG.
Acta Med Scand Suppl. 1981;647:139-44.
Magnesium and potassium interrelationships, experimental
and clinical.
Whang R, Oei TO, Aikawa
JK, Ryan MP, Watanabe
A, Chrysant SG, Fryer
A.
1) Coexisting
Mg and K deficiency may occur with greater frequency than
has been previously appreciated. 2) Profound hypokalemia,
or refractoriness to K repletion or coexisting hypokalemia
and hypocalcemia should suggest the possibility of concurrent
Mg and K depletion. 3) The identification and treatment
of concurrent K and Mg depletion is especially important
in patients with congestive heart failure because of problem
of digitalis toxicity. 4) We believe that the role of magnesium
in optimizing cardiac function remains to be elucidated,
identification and treatment of coexisting Mg and K depletion
will be facilitated by making serum Mg a routine electrolyte
determination together with Na, K, Cl, CO2. ↑ Back To Top
Arch Intern Med. 1988 Nov;148(11):2415-20.
Magnesium metabolism. A review with special reference
to the relationship between intracellular content and serum
levels.
Reinhart RA.
Marshfield Clinic, WI 54449.
Magnesium (Mg++) is a ubiquitous element in nature, playing
a role in photosynthesis and many metabolic functions in
humans. All enzymatic reactions that involve adenosine
triphosphate have an absolute requirement for Mg++. Levels
of Mg++ are controlled by the kidneys and gastrointestinal
tract and appear closely linked to calcium, potassium,
and sodium metabolism. The clinical manifestations
and causes of abnormal Mg++ status are protean. Testing
for altered Mg++ homeostasis is problematic. Serum levels,
which are those generally measured, reflect only a small
part of the total body content of Mg++. The intracellular
content can be low, despite normal serum levels in a person
with clinical Mg++ deficiency. Future directions in research
related to intracellular content of Mg++ are discussed.
Treatment of altered Mg++ status depends on the clinical
setting and may include the addition of a potassium/Mg++-sparing
drug to an existing diuretic regimen. Guidelines for therapy
are given. ↑ Back To Top
J Clin Endocrinol Metab. 1985 Nov;61(5):933-40.
Low serum concentrations of 1,25-dihydroxyvitamin
D in human magnesium deficiency.
Rude RK, Adams JS, Ryzen
E, Endres DB, Niimi H, Horst
RL, Haddad JG Jr, Singer
FR.
The effect of magnesium
deficiency on vitamin D metabolism was assessed in 23 hypocalcemic
magnesium-deficient patients by measuring the serum
concentrations of 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin
D [1,25-(OH)2D] before, during, and after 5-13 days of
parenteral magnesium therapy. Magnesium therapy raised
mean basal serum magnesium [1.0 +/- 0.1 (mean +/- SEM)
mg/dl] and calcium levels (7.2 +/- 0.2 mg/dl) into the
normal range (2.2 +/- 0.1 and 9.3 +/- 0.1 mg/dl, respectively;
P less than 0.001). The mean serum 25OHD concentration
was in the low normal range (13.2 +/- 1.5 ng/ml) before
magnesium administration and did not significantly change
after this therapy (14.8 +/- 1.5 ng/ml). Sixteen of the
23 patients had low serum 1,25-(OH)2D levels (less than
30 pg/ml). After magnesium therapy, only 5 of the patients
had a rise in the serum 1,25-(OH)2D concentration into
or above the normal range despite elevated levels of serum
immunoreactive PTH. An additional normocalcemic hypomagnesemic
patient had low 1,25-(OH)2D levels which did not rise after
5 days of magnesium therapy. The serum vitamin D-binding
protein concentration, assessed in 11 patients, was low
(273 +/- 86 micrograms/ml) before magnesium therapy, but
normalized (346 +/- 86 micrograms/ml) after magnesium repletion.
No correlation with serum 1,25-(OH)2D levels was found.
The functional capacity of vitamin D-binding protein to
bind hormone, assessed by the internalization of [3H]1,25-(OH)2D3
by intestinal epithelial cells in the presence of serum
was not significantly different from normal (11.42 +/-
1.45 vs. 10.27 +/- 1.27 fmol/2 X 10(6) cells, respectively).
These data show that serum 1,25-(OH)2D concentrations are
frequently low in patients with magnesium deficiency and
may remain low even after 5-13 days of parenteral magnesium
administration. The data also suggest that a normal 1,25-(OH)2D
level is not required for the PTH-mediated calcemic response
to magnesium administration. We
conclude that magnesium depletion may impair vitamin D
metabolism. ↑ Back To Top
Alcohol Clin Exp Res. 1992 Oct;16(5):986-90.
Oral magnesium supplementation improves metabolic
variables and muscle strength in alcoholics.
Gullestad L, Dolva LO, Soyland
E, Manger AT, Falch D, Kjekshus
J.
Department of Internal Medicine, Baerum Hospital, Sandvika,
Norway.
Magnesium deficiency is common among chronic alcoholics,
but the knowledge of oral magnesium supplementation to
this group is limited. We, therefore, randomized 49 chronic
alcoholics, moderate to heavy drinkers for at least 10
years to receive oral magnesium or placebo treatment for
6 weeks according to a double-blind protocol. Effects on
metabolic variables and muscle strength were analyzed. Significant
reduction of aspartate-aminotransferase (ASAT), alanine-aminotransferase
(ALAT) and gamma-glutamyl-transpeptidase (GGT) were seen
after magnesium, whereas no change was observed
with placebo. Bilirubin
decreased in both groups. Serum Na, Ca, and P increased
significantly during magnesium therapy compared
with no statistically significant change in the placebo
group. Serum
K and Mg increased slightly after magnesium supplementation
and decreased in the placebo group, resulting in a significant
difference between the two groups at the end of the study.
Muscle strength increased significantly during magnesium
treatment, contrasting to no change with placebo. Blood
pressure, heart rate, hematological variables, serum lipids
(cholesterol, HDL, TG), glucose tolerance, and creatinine
were unchanged in the two groups after treatment. Alcohol
consumption was similar before and during the trial and
does not explain the differences between the two groups
The results shows that short-term oral magnesium therapy
may improve liver cell function, electrolyte status, and
muscle strength in chronic alcoholics. ↑ Back To Top
Br J Nutr. 1996 Dec;76(6):821-3
The effect of long-term calcium supplementation on indices
of iron, zinc and magnesium status in lactating Gambian
women.
Yan Lrentice A, Dibba B, Jarjou
LM, Stirling DM, Fairweather-Tait
S.
Medical Research Council Dunn Nutrition Unit, Cambridge,
The Gambia.
The effect of long-term supplementation with CaCO3
on indices of Fe, Zn and Mg status was investigated
in a randomized, double-blind intervention study of sixty
lactating Gambian women. The supplement contained 1000
mg Ca and was consumed between meals 5 d/week, for 1 year
starting 1.5 weeks postpartum. Compliance was 100%. Plasma
ferritin concentration, plasma Zn concentration and urinary
Mg output were measured before, during and after supplementation
at 1.5, 13, 52 and 78 weeks postpartum. No significant
differences in mineral status were observed at any time
between women in the supplement and placebo groups. Analysis
of the longitudinal data series showed that plasma ferritin
and Mg excretion were characteristic of the individual
(P < 0.001). Within individuals, ferritin concentration
was higher at 1.5 weeks postpartum than later in lactation
(P = 0.002). Plasma Zn concentration was lower at 1.5 weeks
postpartum than at other times (P < 0.001), an effect
which disappeared after albumin correction. Low plasma
concentrations of ferritin and Zn indicated that the Gambian
women were at high risk of Fe and Zn deficiency. Measurements
of alpha 1-antichymotrypsin suggested that the results
were not confounded by acute-phase responses. The results
of the present study indicate that 1000
mg Ca as CaCO3 given between meals does not deleteriously
affect plasma ferritin and Zn concentrations or urinary
Mg excretion in women who are at risk of Fe and
Zn deficiency.
PIP: During March 1990-March 1991, 60 lactating mothers
were recruited into a randomized, placebo-controlled trial
designed to examine the effect of calcium (Ca) supplementation
on plasma zinc (Zn) and ferritin (Fe) concentrations and
on magnesium (Mg) excretion during and after Ca supplementation.
The women lived in Keneba and Manduar villages in rural
Gambia. They consumed 1000 mg Ca or the placebo (2 tablets
of dextrose) between meals 5 days/week for 12 months beginning
1-5 weeks postpartum. All women complied. At no time were
there significant differences in the indices used to determine
Zn, Fe, and Mg status between lactating women on Ca supplements
and those receiving the placebo. In fact, the mean differences
were less than 10% of the total value. Many women (33-50%),
regardless of supplementation group, had a plasma Fe concentration
lower than 12 mcg/l, indicating depleted Fe stores. Many
women also had low plasma Zn levels. Within individuals,
plasma Zn concentrations were 15% lower at day 9 than later
in lactation (p 0.001), while plasma Fe levels were 10%
higher (p = 0.002). Plasma Zn levels were associated with
plasma albumin levels (p 0.001). When adjusted for albumin,
the effect of lactation on Zn disappeared. When compared
with British women, Gambian women had a lower plasma Zn
concentration (p 0.001). Within individuals and after adjustment
for lactation stage and for albumin, plasma Zn levels varied
between seasons (i.e., hot season values higher than other
seasons) (p = 0.004). Women were more likely to excrete
Mg during the hot season (p 0.001). These
findings indicate that ingestion of 1000 mg Ca between
meals has no adverse effect on plasma Fe and Zn levels
or urinary Mg excretion in women at risk of Zn and Fe deficiency. ↑ Back To Top
West J Med. 1990 Feb;152(2):145-8.
Low intracellular magnesium in patients with acute
pancreatitis and hypocalcemia.
Ryzen E, Rude RK.
Department of Medicine, Los Angeles County-University of
Southern California Medical Center.
To determine the role of magnesium deficiency in the pathogenesis
of hypocalcemia in acute pancreatitis, we measured magnesium
levels in serum and in peripheral blood mononuclear cells
in 29 patients with acute pancreatitis, 14 of whom had
hypocalcemia and 15 of whom had normal calcium levels.
Only six patients had overt hypomagnesemia (serum magnesium < 0.70
mmol per liter [I. 7 mg per dl]). The mean serum magnesium
concentration in hypocalcemic patients was not significantly
lower than in normocalcemic patients, but the mononuclear
cell magnesium content in hypocalcemic patients with pancreatitis
was significantly lower than in normocalcemic patients
with pancreatitis (P < .Of). The serum magnesium level
did not correlate with that of serum calcium or the mononuclear
cell magnesium content, but the latter did significantly
correlate with the serum calcium concentration (r = .8l,
P < .001). Most patients with hypocalcemia had a low
intracellular magnesium content. Three normomagnesemic,
hypocalcemic patients with alcoholic pancreatitis also
underwent low-dose parenteral magnesium tolerance testing
and showed increased retention of the magnesium load. We
conclude that patients with acute pancreatitis and hypocalcemia
commonly have magnesium deficiency despite normal serum
magnesium concentrations. Magnesium
deficiency may play a significant role in the pathogenesis
of hypocalcemia in patients with acute pancreatitis. ↑ Back To Top
J Am Coll Nutr. 1990 Apr;9(2):114-9.
Effect of intravenous epinephrine on serum magnesium
and free intracellular red blood cell magnesium concentrations
measured by nuclear magnetic resonance.
Ryzen E, Servis KL, Rude
RK.
Department of Internal Medicine, University of Southern
California, Los Angeles.
Hypomagnesemia
is a common clinical finding in hospitalized patients and
can cause hypocalcemia, cardiac arrhythmias, muscular weakness,
and hypokalemia. Hypomagnesemia usually implies
cellular magnesium (Mg) depletion, but stress and some
clinical conditions which raise serum catecholamine concentrations
may lower serum Mg (sMg) concentrations. To help investigate
the mechanism and degree of the effect of catecholamines
on sMg concentration, we gave intravenous epinephrine (0.1
microgram/kg/min) to 12 normal volunteers for 2 hours.
The sMg concentration fell from 1.86 +/- 0.04 mg/dl to
1.63 +/- 0.05 mg/dl (mean +/- SEM, p less than 0.01). Pre-infusion
intracellular free Mg (Mg++) in red blood cells (RBC) as
measured by nuclear magnetic resonance spectrophotometry
(NMR) was 171 +/- 7.6 microM and did not differ significantly
from post-infusion RBC Mg++, 186 +/- 12.6 microM. Total
blood mononuclear cell Mg content and urine Mg excretion
also did not change. These data suggest that epinephrine
has a small but significant effect on the lowering of sMg
concentrations. Endogenous catecholamine release during
stress or acute illness may therefore contribute to the
hypomagnesemia seen in acutely ill patients. Our data also
suggest that hypomagnesemia seen under conditions of acute
stress may not always imply depleted tissue Mg stores.
As no absolute change in cellular Mg or in urinary Mg excretion
was demonstrated, acute intracellular shifts of Mg into
blood cells and/or urinary Mg losses may not account for
the hypomagnesemia. The prevalence and clinical consequences
of stress hypomagnesemia require further investigation. ↑ Back To Top
Eur J Clin Nutr. 2004 Feb;58(2):270-6. ---
Influence of a mineral water rich in calcium, magnesium
and bicarbonate on urine composition and the risk of calcium
oxalate crystallization.
Siener R, Jahnen A, Hesse A.
Division of Experimental Urology, Department of Urology,
University of Bonn, Bonn, Germany.
OBJECTIVE: To evaluate the effect of a mineral water rich
in magnesium (337 mg/l), calcium (232 mg/l) and bicarbonate
(3388 mg/l) on urine composition and the risk of calcium
oxalate crystallization. DESIGN: A total of 12 healthy
male volunteers participated in the study. During the baseline
phase, subjects collected two 24-h urine samples while
on their usual diet. Throughout the control and test phases,
lasting 5 days each, the subjects received a standardized
diet calculated according to the recommendations. During
the control phase, subjects consumed 1.4 l/day of a neutral
fruit tea, which was replaced by an equal volume of a mineral
water during the test phase. On the follow-up phase, subjects
continued to drink 1.4 l/day of the mineral water on their
usual diet and collected 24-h urine samples weekly. RESULTS:
During the intake of mineral water, urinary pH, magnesium
and citrate excretion increased significantly on both standardized
and normal dietary conditions. The mineral water led to
a significant increase in urinary calcium excretion only
on the standardized diet, and to a significantly higher
urinary volume and decreased supersaturation with calcium
oxalate only on the usual diet. CONCLUSIONS: The
magnesium and bicarbonate content of the mineral water
resulted in favorable changes in urinary pH, magnesium
and citrate excretion, inhibitors of calcium oxalate stone
formation, counterbalancing increased calcium excretion. Since
urinary oxalate excretion did not diminish, further studies
are necessary to evaluate whether the ingestion of calcium-rich
mineral water with, rather than between, meals may complex
oxalate in the gut thus limiting intestinal absorption
and urinary excretion of calcium and oxalate. ↑ Back To Top
J Intensive Care Med. 2005 Jan-Feb;20(1):3-17.
Magnesium deficiency in critical illness.
Tong GM, Rude RK.
University of Southern California, School of Medicine,
Los Angeles, CA 90089-9317, USA.
Magnesium (Mg) deficiency commonly occurs in critical illness
and correlates with a higher mortality and worse clinical
outcome in the intensive care unit (ICU). Magnesium
has been directly implicated in hypokalemia, hypocalcemia, tetany,
and dysrhythmia. Moreover, Mg may play a role in acute
coronary syndromes, acute cerebral ischemia, and asthma. Magnesium
regulates hundreds of enzyme systems. By regulating enzymes
controlling intracellular calcium, Mg affects smooth muscle
vasoconstriction, important to the underlying pathophysiology
of several critical illnesses. The principle causes
of Mg deficiency are gastrointestinal and renal losses;
however, the diagnosis is difficult to make because of
the limitations of serum Mg levels, the most common assessment
of Mg status. Magnesium tolerance testing and ionized Mg2+
are alternative laboratory assessments; however, each has
its own difficulties in the ICU setting. The use of Mg
therapy is supported by clinical trials in the treatment
of symptomatic hypomagnesemia and preeclampsia and is recommended
for torsade de pointes. Magnesium therapy is not supported
in the treatment of acute myocardial infarction and is
presently undergoing evaluation for the treatment of severe
asthma exacerbation, for the prevention of post-coronary
bypass grafting dysrhythmias, and as a neuroprotective
agent in acute cerebral ischemia ↑ Back To Top
Ann Acad Med Stetin. 1997;43:225-38.
[Behavior of selected bio-elements in women with
osteoporosis]
Kotkowiak L. [Article in Polish]
Z Zakladu Medycyny Rodzinnej Pomorskiej Akademii Medycznej
w Szczecinie, Szczecin.
The
purpose of this study was to evaluate the concentration
of calcium, magnesium, zinc and copper in serum, urine
and hair in women with osteoporosis, and to find
out whether deficiency of these bioelements correlates
with BMD. The concentration of calcium, magnesium, zinc
and copper was assessed in 80 women aged 40-68 years. The
women had been menopausal for 9.3 years and had never undergone
hormone replacement, drugs therapy or mineral supplementation.
The bone mass density (BMD) in lumbar spine L2-L4 was measured
in 80 postmenopausal women using dual energy X-ray absorptiometry.
According to BMD values all women were divided into two
groups. The first group (50 persons) comprised women with
osteoporosis. The second group included 30 women without
osteoporosis. After an overnight fasting the levels of
calcium, magnesium, zinc and copper in serum, in urine
and in hair were measured by AAS. Concentration of osteocalcin
and ionized calcium as well as magnesium was also measured
in serum. Calcium, magnesium, zinc and copper excretions
were expressed as a ratio of urinary creatine. Data were
compared with Wilcoxon-Mann-Whitney's test and significance
was assessed at p < 0.05. The regression and correlation
analysis was performed between BMD and level of bioelements.
It was determined that the
mean serum osteocalcin in the examined group (2.067 ng/ml)
was higher than in the control group (1.602 ng/ml).
It was also disclosed that there
was a lower level of total (Tab. 1) and ionized magnesium
in serum (Tab. 2) and reduced excretion of this
element in urine (Tab. 4) of fasting women with osteoporosis.
The concentrations of calcium, zinc and copper in serum
(Tab. 1) and in urine (Tab. 4) in both groups were similar
to laboratory normal range. Hair calcium and magnesium
levels in examined group were lower in comparison with
the control group (Tab. 3). Concentrations of zinc and
copper in hair were similar in both groups (Tab. 3). The
study found out that women with osteoporosis displayed
magnesium deficiency. The results showed that highly significant
correlation existed between magnesium and calcium.
No significant relationship between BMD and the concentration
of bioelements was observed. ↑ Back To Top
Intern Med. 2004 May;43(5):410-4.
Depressive state and paresthesia dramatically improved
by intravenous MgSO4 in Gitelman's syndrome.
Enya M, Kanoh Y, Mune
T, Ishizawa M, Sarui
H, Yamamoto M, Takeda
N, Yasuda K, Yasujima
M, Tsutaya S, Takeda
J.
Third Department of Internal Medicine, Gifu University
School of Medicine, 40 Tsukasa-machi, Gifu 500-8705.
A 69-year-old woman was referred to our department for
evaluation of hypokalemia, which had been treated by oral
potassium for more than ten years. She complained of headache,
knee joint pain, sleeplessness and paresthesia in extremities
and, most prominently, depression. Laboratory data suggested Gitelman's
syndrome, which is caused by mutations in the gene
encoding the thiazide-sensitive Na-Cl cotransporter. Direct
sequencing of the gene in this patient revealed homozygous
mutation R964Q in exon 25. Intravenous
supplement of MgSO4 dramatically improved both the depression
and the paresthesia, suggesting that hypomagnesemia
played a role in the clinical manifestations. ↑ Back To Top
Arch Intern Med. 1988 Aug;148(8):1801-5.
The effect of intravenous magnesium therapy on
serum and urine levels of potassium, calcium, and sodium
in patients with ischemic heart disease, with and without
acute myocardial infarction.
Rasmussen HS, Cintin C, Aurup P, Breum L, McNair P.
Medical Department P/Chest Clinic, Bispebjerg Hospital.
Serum concentrations of magnesium, potassium, calcium,
and sodium were determined on admission of 224 patients
to the hospital and after 2, 4, and 6 days in hospital;
all were admitted to the hospital with suspected acute
myocardial infarction (AMI). On admission, the patients
were randomly allocated to 48 hours of treatment with magnesium
intravenously or placebo. One hundred twenty-three patients
had AMI (of whom 53 [43%] were treated with magnesium)
and 101 had their suspected AMI disproven (of whom 51 [50%]
were treated with magnesium). In a supplementary study,
serum and urine levels of magnesium, potassium, calcium,
and sodium, together with serum levels of parathyroid hormone,
were determined before and after intravenous magnesium
treatment in six patients with AMI and six patients with
ischemic heart disease but without AMI. In both studies,
magnesium therapy was associated with significant alterations
in extracellular ion homeostasis. Serum
concentrations of potassium decreased during the
initial days of hospitalization in the patients treated
with placebo, but increased
slightly in the patients treated with magnesium infusions. These
increments in the serum concentrations of magnesium and
potassium correlated significantly. The increase in the
serum concentration of potassium after magnesium infusions
was due
to a reduced renal potassium excretion level (from
71.3 to 49.4 mmol/24 h), indicating the existence of a
divalent-monovalent cation exchange mechanism in the nephron.
This hypothesis was supported by the observation that renal
sodium excretion likewise decreased after magnesium infusions (from
83.2 to 59.2 mmol/24 h). Serum
concentration of calcium decreased significantly after
magnesium treatment (from 2.35 mmol/L on admission
to 2.15 mmol/L after 24 hours in the hospital) in the AMI
group, in contrast to the placebo-treated patients, where
no significant fluctuations in serum concentration of calcium
were detected during the initial six days. This decrease
in serum concentration of calcium was due
to a marked increase in renal calcium excretion (from
3.43 mmol/24 h before to 6.59 mmol/24 h after magnesium
infusion). A correlation between increments in serum magnesium
concentration and decrements in serum calcium concentration
was detected. No change in serum levels of parathyroid
hormone was found before and after magnesium infusions.
Both serum and urine levels of magnesium significantly
increased after magnesium treatment to levels above the
upper normal limits (serum magnesium concentration increased
from 0.81 to 1.21 mmol/L, urine magnesium excretion levels
from 3.57 to 16.57 mmol/24 h for both serum and urine changes. ↑ Back To Top
Clin Endocrinol (Oxf). 1976 May;5(3):209-24.
Functional hypoparathyroidism and parathyroid hormone
end-organ resistance in human magnesium deficiency.
Rude RK, Oldham SB, Singer FR.
Hypocalcaemia
is a well-recognized manifestation of magnesium deficiency.
We have studied seventeen patients with this syndrome in
an attempt to determine the pathogenesis of the hypocalcaemia.
Mean initial serum calcium concentration was 5-6 mg/dl
and mean initial serum magnesium concentration was 0-75
mg/dl. Serum immunoreactive parathyroid hormone (IPTH)
was measured in sixteen patients in the untreated state.
Despite severe hypocalcaemia, serum IPTH was either undetectable
(less than 150 pg/ml) or normal (less than 550 pg/ml) in
all but two patients. Serial measurements made during the
initial 4 days of magnesium therapy in four patients showed
an increase in serum IPTH within 24h, but a delayed increase
in serum calcium, which required approximately 4 days to
reach normal values. The effect of the rapid normalization
of serum magnesium on serum IPTH and serum calcium concentration
was studied in three patients. Within 1 min after 144-300
mg of elemental magnesium was administered i.v., serum
IPTH had risen from undetectable to 3600 pg/ml and 1725
pg/ml in two patients and from 425 pg/ml to 937 pg/ml in
the third. Serum calcium concentrations were unchanged
after 30-60 min. These data provide evidence for impaired
parathyroid gland function in most of the magnesium deficient
patients. The rapidity with which serum IPTH rose in response
to magnesium therapy indicates that this may reflect a
defect in parathyroid hormone (PTH) secretion rather than
its biosynthesis. The failure of serum calcium concentration
to increase during the initial days of magnesium repletion,
at a time when serum IPTH concentrations were normal or
elevated, suggests end-organ resistance to PTH in these
patients. The renal response to PTH was examined in two
magnesium deficient patients by measurement of urinary
cyclic AMP excretion following administration of parathyroid
extract. In both patients there was a minimal increase
in urinary cyclic AMP concentrations. In contrast, when
the hepatic response to glucagon was tested on the same
patients by measurement of plasma cyclic AMP concentrations
following administration of glucagon, normal increases
were observed. These results suggest that adenylate cyclase
systems of various organs may be affected differentially
by a state of magnesium deficiency. It is suggested that
magnesium deficiency may result in defective cyclic AMP
generation in the parathyroid glands and in the PTH target
organs. This could be the principal mechanism operative
in both impaired PTH secretion and end-organ resistance ↑ Back To Top
J Clin Endocrinol Metab. 1969 Jun;29(6):842-8.
Hypocalcemia
due to hypomagnesemia and reversible parathyroid
hormone unresponsiveness.
Estep H Shaw WA, Watlington C, Hobe R, Holland
W, Tucker SG.
Acta Med Scand Suppl. 1981;647:139-44.
Magnesium and potassium interrelationships, experimental
and clinical.
Whang R, Oei TO, Aikawa
JK, Ryan MP, Watanabe
A, Chrysant SG, Fryer
A.
1) Coexisting
Mg and K deficiency may occur with greater frequency than
has been previously appreciated. 2) Profound hypokalemia,
or refractoriness to K repletion or coexisting hypokalemia
and hypocalcemia should suggest the possibility of concurrent
Mg and K depletion. 3) The identification and treatment
of concurrent K and Mg depletion is especially important
in patients with congestive heart failure because of problem
of digitalis toxicity. 4) We believe that the role of magnesium
in optimizing cardiac function remains to be elucidated,
identification and treatment of coexisting Mg and K depletion
will be facilitated by making serum Mg a routine electrolyte
determination together with Na, K, Cl, CO2. ↑ Back To Top
Arch Intern Med. 1988 Nov;148(11):2415-20.
Magnesium metabolism. A review with special reference
to the relationship between intracellular content and serum
levels.
Reinhart RA
Marshfield Clinic, WI 54449.
Magnesium (Mg++) is a ubiquitous element in nature, playing
a role in photosynthesis and many metabolic functions in
humans. All enzymatic reactions that involve adenosine
triphosphate have an absolute requirement for Mg++. Levels
of Mg++ are controlled by the kidneys and gastrointestinal
tract and appear closely linked to calcium, potassium,
and sodium metabolism. The clinical manifestations
and causes of abnormal Mg++ status are protean. Testing
for altered Mg++ homeostasis is problematic. Serum levels,
which are those generally measured, reflect only a small
part of the total body content of Mg++. The intracellular
content can be low, despite normal serum levels in a person
with clinical Mg++ deficiency. Future directions in research
related to intracellular content of Mg++ are discussed.
Treatment of altered Mg++ status depends on the clinical
setting and may include the addition of a potassium/Mg++-sparing
drug to an existing diuretic regimen. Guidelines for therapy
are given. ↑ Back To Top
J Clin Endocrinol Metab. 1985 Nov;61(5):933-40.
Low serum concentrations of 1,25-dihydroxyvitamin
D in human magnesium deficiency.
Rude RK, Adams JS, Ryzen E, Endres DB, Niimi H, Horst RL,
Haddad JG Jr, Singer FR.
The effect of magnesium
deficiency on vitamin D metabolism was assessed in 23 hypocalcemic
magnesium-deficient patients by measuring the serum
concentrations of 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin
D [1,25-(OH)2D] before, during, and after 5-13 days of
parenteral magnesium therapy. Magnesium therapy raised
mean basal serum magnesium [1.0 +/- 0.1 (mean +/- SEM)
mg/dl] and calcium levels (7.2 +/- 0.2 mg/dl) into the
normal range (2.2 +/- 0.1 and 9.3 +/- 0.1 mg/dl, respectively;
P less than 0.001). The mean serum 25OHD concentration
was in the low normal range (13.2 +/- 1.5 ng/ml) before
magnesium administration and did not significantly change
after this therapy (14.8 +/- 1.5 ng/ml). Sixteen of the
23 patients had low serum 1,25-(OH)2D levels (less than
30 pg/ml). After magnesium therapy, only 5 of the patients
had a rise in the serum 1,25-(OH)2D concentration into
or above the normal range despite elevated levels of serum
immunoreactive PTH. An additional normocalcemic hypomagnesemic
patient had low 1,25-(OH)2D levels which did not rise after
5 days of magnesium therapy. The serum vitamin D-binding
protein concentration, assessed in 11 patients, was low
(273 +/- 86 micrograms/ml) before magnesium therapy, but
normalized (346 +/- 86 micrograms/ml) after magnesium repletion.
No correlation with serum 1,25-(OH)2D levels was found.
The functional capacity of vitamin D-binding protein to
bind hormone, assessed by the internalization of [3H]1,25-(OH)2D3
by intestinal epithelial cells in the presence of serum
was not significantly different from normal (11.42 +/-
1.45 vs. 10.27 +/- 1.27 fmol/2 X 10(6) cells, respectively).
These data show that serum 1,25-(OH)2D concentrations are
frequently low in patients with magnesium deficiency and
may remain low even after 5-13 days of parenteral magnesium
administration. The data also suggest that a normal 1,25-(OH)2D
level is not required for the PTH-mediated calcemic response
to magnesium administration. We
conclude that magnesium depletion may impair vitamin D
metabolism. ↑ Back To Top
Alcohol Clin Exp Res. 1992 Oct;16(5):986-90.
Oral magnesium supplementation improves metabolic
variables and muscle strength in alcoholics.
Gullestad L, Dolva LO, Soyland
E, Manger AT, Falch D, Kjekshus
J.
Department of Internal Medicine, Baerum Hospital, Sandvika,
Norway.
Magnesium deficiency is common among chronic alcoholics,
but the knowledge of oral magnesium supplementation to
this group is limited. We, therefore, randomized 49 chronic
alcoholics, moderate to heavy drinkers for at least 10
years to receive oral magnesium or placebo treatment for
6 weeks according to a double-blind protocol. Effects on
metabolic variables and muscle strength were analyzed. Significant
reduction of aspartate-aminotransferase (ASAT), alanine-aminotransferase
(ALAT) and gamma-glutamyl-transpeptidase (GGT) were seen
after magnesium, whereas no change was observed
with placebo. Bilirubin
decreased in both groups. Serum Na, Ca, and P increased
significantly during magnesium therapy compared
with no statistically significant change in the placebo
group. Serum
K and Mg increased slightly after magnesium supplementation
and decreased in the placebo group, resulting in a significant
difference between the two groups at the end of the study.
Muscle strength increased significantly during magnesium
treatment, contrasting to no change with placebo. Blood
pressure, heart rate, hematological variables, serum lipids
(cholesterol, HDL, TG), glucose tolerance, and creatinine
were unchanged in the two groups after treatment. Alcohol
consumption was similar before and during the trial and
does not explain the differences between the two groups
The results shows that short-term oral magnesium therapy
may improve liver cell function, electrolyte status, and
muscle strength in chronic alcoholics. ↑ Back To Top
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