Hypomagnesemia - Hypermagnesemia

1. Magnesium
disorders
Facts, numbers, and guidelines

2. 883 - 894
Group 7
COVID-19
|
2020

3. Table of Contents:
Introduction.
01 02
Hypomagnesaemia.
Hypermagnesemia.
03 04
Management.

4. Introduction
COVID-19
|
2020
01

5. ● Magnesium is the 2nd most abundant
intracellular ion, present in many foods,
available as a dietary supplement, and present in
some medicines.
● Magnesium is a cofactor in more than 300
enzyme systems that regulate diverse
biochemical reactions in the body.

6. ● An adult body contains approximately 25 g
magnesium, with 99% present in the bones
and soft tissues
● Less than 1% of total magnesium is in blood
serum.
● The normal range for blood magnesium level
is 1.8 to 2.2 mg/dL.

7. HYPOMAGNESEMIA
02

8. Hypomagnesaemia
is a condition where the serum magnesium concentration < 1.8 mg/dL.

9. Causes of Hypomagnesaemia:
+Polyuria
+Extracellular fluid volume expansion (PCT)
+Diuretics (e.g LOOP (TAL) --- Thiazide (DCT) )
+Malignant bone metastasis decreases Mg reabsorption .
+Gastrointestinal (GI) diseases.
+Alcohol dependence.
+Type 2 diabetes.
+Treatment with certain chemotherapies e.g Cetuximab .

10. clinical manifestations
-Hypokalemia due to releasing the
inhibition of ROMK.
-Hypocalcaemia due to
hypoparathyroidism
- worsen insulin resistance.
1) Electrolyte haemostasis:

11. clinical manifestations
-Decrese skeletal growth because Mg
is considered as a mitogenic for
bone cell growth .
-Increase fragility.
2) Skeletal system:

12. clinical manifestations
-Tremors
- Tetany & Hyperexcitability :
. +ve Chovestek’s sign
. +ve Trousseau’s sign
3)Neuromuscular manifestations:

13. clinical manifestations
-Seizures ( in severe cases )
. Due to Releasing the inhibition of NMDA receptors

14. clinical manifestations
-ECG :
. Peaked T waves
. Widened QRS complex
-Ventricular arrhythmia ( torsade de point )
-Atrial fibrillation
4)Cardiovascular manifestations:

15. Diagnosis:
1- Measurement of the concentration of
magnesium in the serum.
Other symptoms include hypocalcemia and
hypokalemia, which usually include increased
urine potassium and metabolic alkalosis.
2-Comprhensive metabolic panel.

16. Management:

17. HYPERMAGNESEMIA
03

18. Magnesium concentrations of 2.6 mg/dL or above are
considered hypermagnesemia.

19. Clinical manifestations:
+Majority of the patient are asymptomatic when the hypermagnesemia is mild
+The clinical manifestations of hypermagnesemia are largely caused by the effect
of the neuromusclar and cardiovascular systems and electrolyte disturbances and
related to the level of magnesium in blood

20. clinical manifestations:
● The disease can lead to a coma if the levels are higher than 15.6 mg/dL

21. Diagnosis:
1-History
2-ECG:Changes similar of those of hyperkalemia:
3- Lab results:
○ Blood free magnesium level
○ Renal function test :Urea, creatinine clearance test
(increase with renal failure)

22. Management: Depend on severity.

23. Refrences
1. Lisanne M.M. Gommers, Joost G.J. Hoenderop, René J.M. Bindels, Jeroen H.F. de
Baaij; Hypomagnesemia in Type 2 Diabetes: A Vicious Circle?. Diabetes 1 January
2016; 65 (1): 3–13. https://doi.org/10.2337/db15-1028
2. First Aid Clinical Pattern Recognition for The USMLE Step 1
3. Gragossian A, Bashir K, Friede R. Hypomagnesemia. [Updated 2021 Nov 8]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK500003/
4. Courtney M. Townsend JR., MD, in Sabiston Textbook of Surgery, 2022
5. Mina El Kateb, Joel M. Topf, in Nephrology Secrets (Fourth Edition), 2019
6. Cascella M, Vaqar S. Hypermagnesemia. [Updated 2022 Feb 5]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK549811/