Hypomagnesemia

Hypomagnesemia Definition

Hypomagnesemia is an electrolyte disturbance arising due to unusually low magnesium levels in the bloodstream [1]. It is a congenital error.

It is also known as:

  • Hypomagnesaemia
  • Low blood magnesium

Hypomagnesemia Epidemiology

The incidence has been assessed to be lower than 2% in the general population [2]. As per certain studies, 75% of Americans do not consume magnesium as much as dietary standards recommend.

Hypomagnesemia Symptoms

The common signs and symptoms include [3]:

  • Athetosis
  • Cardiac arrhythmia
  • Fatigue
  • Abnormal eye movements (nystagmus)
  • Numbness
  • Jerking
  • Extensor plantar reflex
  • Convulsions
  • High blood pressure (hypertension)
  • Muscle weakness
  • Muscle spasms or cramps
  • Increased nervous system irritability (along with tremors)

Additional problems include:

  • Confusion
  • Tachycardia
  • Tetany
  • Depression
  • Epileptic fits
  • Hypertension
  • Hallucinations
  • Mental disorientation

Hypomagnesemia Etiology

The causes for the disease include:

  • Alcoholism
  • Chronic diarrhea
  • Sweating
  • Malnutrition
  • Gitelman Syndrome
  • Hyperaldosteronism
  • High blood calcium levels (hypercalcemia)
  • Malabsorption syndromes, such as inflammatory bowel disease and celiac disease
  • Medications (amphotericin, cyclosporine, cisplatin,diuretics, aminoglycoside antibiotics etc)
  • Excessive urination (polyuria), as in unmanaged diabetes and during recovery from acute kidney failure
  • Intravenous fluids without magnesium supplementation (during hospitalization) [4].

Hypomagnesemia Risk Factors

Those with low dietary magnesium intake are at greater risk. Susceptibility is also increased in patients who are hospitalized due to some condition or other; around 10% in regular wards and about 60% in ICU. Premature newborn babies are highly susceptible due to prolonged hospitalization in ICU. This occurs due to intravenous fluid administration without magnesium supplementation.

Other risk factors include [5]:

  • Vomiting and diarrhea
  • Highly processed foods
  • Alcoholism or prolonged, heavy alcohol use
  • Heredity
  • Acute injuries, heart attacks, surgery or burns
  • Health conditions (diabetes, bowel disorders, some forms of kidney disorders)
  • Medications, such as antibiotics, diuretics, proton pump inhibitors (drugs for reflux), insulin, and some types of chemotherapy

Hypomagnesemia Diagnosis

Diagnosis of Hypomagnesemia involves a complete physical examination to check for signs like:

  • Low blood calcium level (hypocalcemia)
  • Electrocardiogram (ECG) changes
  • Low blood potassium level (hypokalemia)

Other diagnostic tests include:

  • Blood tests (plasma magnesium concentration)
  • Urine tests (24-hour urine test, to check magnesium outflow within a day)
  • Magnesium blood test
  • Urine magnesium test
  • Comprehensive metabolic panel

Hypomagnesemia Differential Diagnosis

DDX involves distinguishing the signs of Hypomagnesemia from those of Hypokalemia and Hypocalcemia [6].

Hypomagnesemia Treatment

Treatment depends on the degree of magnesium deficiency and the clinical symptoms. Medical cure involves [7]:

  • Oral replacement therapy (for mild symptoms)
  • Intravenous replacement (in case of acute clinical symptoms)
  • Various oral magnesium preparations (Magnesium oxide, Magnesium citrate)
  • Intravenous magnesium sulfate (MgSO4), to cure cardiac arrhythmias and pre-eclampsia
  • Some diuretics having magnesium-sparing properties, like amiloride and spironolactone (in cases resulting from renal magnesium wasting)

Medical treatment aims at alleviating the symptoms and restoring magnesium balance in the body.

Diet

Dietary management involves consumption of magnesium-rich foods, such as:

  • Nuts
  • Seeds
  • Whole, unrefined grains
  • Legumes (like peas and beans)
  • Green vegetables, such as spinach

Hypomagnesemia can be life-threatening and medical assistance should be sought in case of symptoms.

Hypomagnesemia Prognosis

The outcome is excellent when the magnesium deficiency is corrected. In most patients, treatment helps reverse the symptoms. Prognosis usually depends on curing the underlying condition.

Hypomagnesemia Complications

The possible complications include:

  • Cardiac arrest
  • Respiratory arrest
  • Death
  • Hypocalcemia (reduced surum calcium levels), due to inhibition of parathyroid hormone bioactivity (hypoparathyroidism)
  • Increased intracellular calcium level

Hypomagnesemia Prevention

Avoidance of Hypomagnesemia can lie in treating the underlying disorder. People involved in highly demanding sports activities should drink fluids containing electrolytes (sports drinks). Drinking only water while participating in high-energy athletic events can result in acute hypomagnesemia.

Other preventive measures include:

  • Limiting alcohol intake
  • Managing underlying health conditions

Hypomagnesemia ICD9 Code

The ICD9 Code for this disease is 275.2.

References

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