An overview of diagnosis and management of drug‐induced hypomagnesemia

Abstract

Hypomagnesemia is usually defined as a serum magnesium (Mg) level below 0.65 mmol/L (1.3 mEq/L; 1.5 mg/dl). 1 Serum Mg exists in three forms: (1) free or ionized Mg, the physiologically active form that accounts for 55%-70% of total serum Mg; (2) Mg complexed to anions, including bicarbonates, sulfates, phosphates, and citrates (5%-15%) and (3) Mg bound to serum proteins (primarily albumin), constituting the remaining approximately 30%. 2 Similarly to hypocalcemia, hypoalbuminemia is also related to spurious hypomagnesemia. 3 Consequently, in hypoalbuminemic states (serum albumin <4 g/dl) corrected serum Mg should be calculated using the formula: corrected Mg (mmol/L) = measured Mg(mmol/L) + 0.005 × (40 − albumin g/L). 4 Correction of Mg for albumin levels is rarely performed in clinical practice, a strategy that should probably change.The incidence of hypomagnesemia varies considerably from merely 2% among individuals in the community up to as high as 65% in patients hospitalized in intensive care units. 5,6 Discrepancies in the reported incidences of hypomagnesemia are attributed to the fact that serum Mg is not routinely measured and that this ion is

Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

“…Excessive alcohol intake can be associated with hypomagnesemia. This could be due to multiple mechanisms, including decreased magnesium intake, increased gastrointestinal Mg losses in patients with chronic diarrhea, increased Mg entry into cells due to both respiratory alkalosis and excessive catecholamine release in alcohol withdrawal syndrome, inappropriate urinary losses due to alcohol-induced tubular damage, alcohol-related metabolic acidosis, and acute pancreatitis [ 17 , 18 ].…”

“…Hypomagnesemia has been reported to cause carpopedal spasm, tetany, convulsions, cardiac arrhythmias, hypoparathyroidism, hypocalcemia, hypophosphatasemia, muscle cramps or weakness, vertigo, ataxia, seizures, depression, and psychosis [ 16 , 18 ]. Hypomagnesemia typically recurs following replacement of one proton pump inhibitor with another [ 19 ].…”

Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review

“…Some antineoplastic agents (i.e., cisplatin) and birth control pills cause an increased renal excretion of magnesium. Finally, calcineurin inhibitors and iron-based phosphate intestinal binders are also associated with hypomagnesaemia [ 39 ].…”

“…A condition of hypocalcemia may be the result of four different conditions [ 39 , 41 ]: hypoparathyroidism, hypovitaminosis D, calcium binding agents, or impaired bone resorption. Medications most often associated with hypocalcemia are loop diuretics (for increased calcium excretion), chelating agents (i.e., ethylenediaminetetracetate, citrate, phosphate), antineoplastic drugs (i.e., cisplatin, leucovorin, 5-fluorouracil, nab-paclitaxel, axitinib), biphosphates, calcitonin and denosumab (a monoclonal antibody used to treat osteoporosis).…”

Trastornos Electrolíticos

“…El nivel normal es de 1,5 a 3,0mEq/L; en el organismo se encuentra en tres estados: Mg ionizado o libre 55-70% es la forma activa; ligado a proteínas (albúmina) 30% y formando complejos aniónicos (bicarbonato, sulfatos, fosfatos y citratos) 5-15% (24,25); debido a que la mayor parte del Mg es intracelular, el nivel sérico no siempre refleja la concentración corporal total (22).…”