Magnesium deficiency is an
electrolyte disturbance in which there is a low level of
magnesium
Magnesium is a chemical element; it has Symbol (chemistry), symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 ...
in the body. Symptoms include
tremor
A tremor is an involuntary, somewhat rhythmic muscle contraction and relaxation involving neural oscillations, oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the h ...
, poor coordination,
muscle spasms,
loss of appetite,
personality changes, and
nystagmus.
[ Complications may include ]seizures
A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
or cardiac arrest
Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...
such as from torsade de pointes.[ Those with low magnesium often have low potassium.][
Causes include low dietary intake, ]alcoholism
Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...
, diarrhea
Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...
, increased urinary loss, and poor absorption from the intestines. Some medications may also cause low magnesium, including proton pump inhibitors
Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of gastric acid, stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase, H+/K+ ATPase proton pump. The body ...
(PPIs) and furosemide.[ The diagnosis is typically based on finding low blood magnesium levels, also called hypomagnesemia.] Normal magnesium levels are between 0.6 and 1.1 mmol/L (1.46–2.68 mg/dL) with levels less than 0.6 mmol/L (1.46 mg/dL) defining hypomagnesemia.[ Specific electrocardiogram (ECG) changes may be seen.][
Treatment is with magnesium either by mouth or intravenously.][ For those with severe symptoms, intravenous ]magnesium sulfate
Magnesium sulfate or magnesium sulphate is a chemical compound, a salt with the formula , consisting of magnesium cations (20.19% by mass) and sulfate anions . It is a white crystalline solid, soluble in water but not in ethanol.
Magnesi ...
may be used.[ Associated low potassium or low calcium should also be treated.][ The condition is relatively common among people in hospitals.]
Signs and symptoms
Deficiency of magnesium can cause tiredness, generalized weakness, muscle cramps
A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity. While generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the affe ...
, abnormal heart rhythms, increased irritability of the nervous system
In biology, the nervous system is the complex system, highly complex part of an animal that coordinates its behavior, actions and sense, sensory information by transmitting action potential, signals to and from different parts of its body. Th ...
with tremor
A tremor is an involuntary, somewhat rhythmic muscle contraction and relaxation involving neural oscillations, oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the h ...
s, paresthesia
Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or Chronic condition, chronic and has many possible underlying causes. Paresthesia is usually p ...
s, palpitations
Palpitations occur when a person becomes aware of their heartbeat. The heartbeat may feel hard, fast, or uneven in their chest.
Symptoms include a very fast or irregular heartbeat. Palpitations are a sensory symptom. They are often described as ...
, low potassium levels in the blood, hypoparathyroidism which might result in low calcium levels in the blood, chondrocalcinosis, spasticity
Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles. ...
and tetany, migraine
Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...
s, epileptic seizure
A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
s, basal ganglia calcifications and in extreme and prolonged cases coma
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to Nociception, respond normally to Pain, painful stimuli, light, or sound, lacks a normal Circadian rhythm, sleep-wake cycle and does not initiate ...
, intellectual disability
Intellectual disability (ID), also known as general learning disability (in the United Kingdom), and formerly mental retardation (in the United States), Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010).Archive is a generalized neurodevelopmental ...
or death. Magnesium deficiency is strongly associated with and appears to contribute to obesity
Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
, insulin resistance, metabolic syndrome
Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).
Metabolic syndro ...
, and type 2 diabetes
Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent ...
, although the causal mechanism is not fully understood.
Causes
Magnesium deficiency may result from gastrointestinal or kidney causes. Gastrointestinal causes include low dietary magnesium intake, reduced gastrointestinal absorption, or increased gastrointestinal loss due to rapid gastrointestinal transits. Kidney causes involve increased excretion of magnesium. Poor dietary intake of magnesium has become an increasingly important factor: many people consume diets high in refined foods such as white bread
White bread typically refers to breads made from wheat flour from which the bran and the germ layers have been removed from the whole wheatberry as part of the flour grinding or milling process, producing a light-colored flour.
Nutrition
Wh ...
and polished rice which have been stripped of magnesium-rich plant fiber.
Magnesium deficiency is common in hospitalized patients. Up to 12% of all people admitted to hospital
A hospital is a healthcare institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...
, and as high as 60–65% of people in an intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.
An inten ...
(ICU), have hypomagnesemia.
About 57% of the US population does not meet the US RDA for dietary magnesium intake. Kidneys are very efficient at maintaining body levels; however, if the diet is deficient, or certain medications such as diuretics or proton pump inhibitors are used, or in chronic alcoholism
Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...
,[ levels may drop.
Deficiencies may be due to the following conditions:
]
Medications
* Loop and thiazide diuretic use (the most common cause of hypomagnesemia),
* Antibiotics (i.e. aminoglycoside, amphotericin, pentamidine, gentamicin
Gentamicin is an aminoglycoside antibiotic used to treat several types of bacterial infections. This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, and sepsis amo ...
, tobramycin
Tobramycin is an aminoglycoside antibiotic derived from '' Streptomyces tenebrarius'' that is used to treat various types of bacterial infections, particularly Gram-negative infections. It is especially effective against species of ''Pseudomo ...
, viomycin) block resorption in the loop of Henle
In the kidney, the loop of Henle () (or Henle's loop, Henle loop, nephron loop or its Latin counterpart ''ansa nephroni'') is the portion of a nephron that leads from the proximal convoluted tubule to the distal convoluted tubule. Named after it ...
. 30% of patients using these antibiotics have hypomagnesemia,
* Long term, high dosage use of proton-pump inhibitors such as omeprazole,
* Other drugs:
** Digitalis
''Digitalis'' ( or ) is a genus of about 20 species of herbaceous perennial plants, shrubs, and Biennial plant, biennials, commonly called foxgloves.
''Digitalis'' is native to Europe, Western Asia, and northwestern Africa. The flowers are ...
, displaces magnesium into the cell. Digitalis causes an increased intracellular concentration of sodium, which in turn increases intracellular calcium by passively increasing the action of the sodium-calcium exchanger in the sarcolemma
The sarcolemma (''sarco'' (from ''sarx'') from Greek; flesh, and ''lemma'' from Greek; sheath), also called the myolemma, is the cell membrane surrounding a skeletal muscle fibre or a cardiomyocyte.
It consists of a lipid bilayer and a thin ...
. The increased intracellular calcium gives a positive inotropic effect,
** Adrenergics, displace magnesium into the cell,
** Cisplatin
Cisplatin is a chemical compound with chemical formula, formula ''cis''-. It is a coordination complex of platinum that is used as a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, c ...
, stimulates kidney excretion,
** Ciclosporin
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken Oral administration, orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephr ...
, stimulates kidney excretion,
** Mycophenolate mofetil.
Genetics
* Gitelman-like diseases, which include the syndromes caused by genetic mutations in '' SLC12A3'', '' CLNCKB'', '' BSND'', '' KCNJ10'', '' FXYD2'', '' HNF1B'' or '' PCBD1''. In these diseases, the hypomagnesemia is accompanied by other defects in electrolyte handling such as hypocalciuria and hypokalemia. The genes involved in this group of diseases all encode proteins that are involved in reabsorbing electrolytes (including magnesium) in the distal convoluted tubule of the kidney,
* Hypercalciuric hypomagnesemic syndromes, which encompass the syndromes caused by mutations in '' CLDN16'', '' CLDN19'', '' CASR'' or '' CLCNKB''. In these diseases, reabsorption of divalent cations (such as magnesium and calcium) in the thick ascending limb of Henle's loop of the kidney is impaired. This results in loss of magnesium and calcium in the urine,
* Mitochondriopathies, especially mutations in the mitochondrial tRNAs '' MT-TI'' or '' MT-TF.'' Mutations in '' SARS2,'' or mitochondrial DNA deletions as seen with Kearns-Sayre syndrome, can also cause hypomagnesemia,
* Other genetic causes of hypomagnesemia, such as mutations in '' TRPM6'', '' CNNM2'', '' EGF'', '' EGFR'', '' KCNA1'' or '' FAM111A''. Many of the proteins encoded by these genes play a role in the transcellular absorption of magnesium in the distal convoluted tubule,
Metabolic abnormalities
* Insufficient selenium
Selenium is a chemical element; it has symbol (chemistry), symbol Se and atomic number 34. It has various physical appearances, including a brick-red powder, a vitreous black solid, and a grey metallic-looking form. It seldom occurs in this elem ...
, vitamin D or sunlight exposure, or vitamin B6
Vitamin B6 is one of the B vitamins, and is an essential nutrient for humans. The term essential nutrient refers to a group of six chemically similar compounds, i.e., "vitamers", which can be interconverted in biological systems. Its active f ...
,
* Gastrointestinal causes: the distal digestive tract secretes high levels of magnesium. Therefore, secretory diarrhea can cause hypomagnesemia. Thus, Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...
, ulcerative colitis
Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary sympto ...
, Whipple's disease and celiac sprue
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine. Patients develop hypersensitivity, intolerance to gluten, which is present in foods such as wh ...
can all cause hypomagnesemia,
* Postobstructive diuresis, diuretic phase of acute tubular necrosis (ATN) and kidney transplant,
Other
* Chronic alcoholism: Alcohol intake leads to enhanced diuresis of electrolytes, possibly due to alcohol-induced kidney tubular cell damage. Hypomagnesemia is also thought to occur due to reduced magnesium intake due to malnutrition and increased gastrointestinal losses. Hypomagnesemia is the most common electrolyte abnormality in those with chronic alcoholism. Chronic hypomagnesemia in those with chronic alcoholism is associated with liver disease
Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common.
Liver diseases
File:Ground gla ...
and a worse prognosis,
* Acute myocardial infarction: within the first 48 hours after a heart attack, 80% of patients have hypomagnesemia. This could be the result of an intracellular shift because of an increase in catecholamines,
* Malabsorption
Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a varie ...
,
* Acute pancreatitis,
* Fluoride poisoning,
* Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications.
Pathophysiology
Magnesium is ubiquitous in the human body as well as being present in all living organisms and the ion is a known co-factor in over known 300 enzymatic reactions including DNA and RNA replication, protein synthesis, acting as an essential co-factor of ATP during its phosphorylation via ATPase
ATPases (, Adenosine 5'-TriPhosphatase, adenylpyrophosphatase, ATP monophosphatase, triphosphatase, ATP hydrolase, adenosine triphosphatase) are a class of enzymes that catalyze the decomposition of ATP into ADP and a free phosphate ion or ...
. It is also extensively involved in intracellular signaling. It is involved in protein synthesis
Protein biosynthesis, or protein synthesis, is a core biological process, occurring inside cells, balancing the loss of cellular proteins (via degradation or export) through the production of new proteins. Proteins perform a number of critica ...
, regulating glucose, lipid and protein metabolism, muscle and nerve functioning, vascular tone (affecting blood vessel contraction, thus helping to regulate blood pressure), bone development, energy production, the maintenance of normal heart rhythm, and the regulation of glucose
Glucose is a sugar with the Chemical formula#Molecular formula, molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae d ...
, among other important roles. Physiologically, it acts as a calcium antagonist. Thus, the effects of low magnesium are widespread. Low magnesium intake over time can increase the risk of illnesses, including high blood pressure
Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...
and heart disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...
, diabetes mellitus type 2, osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
, and migraine
Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...
s.[
Magnesium has several effects:
]
Potassium
Low potassium
Potassium is a chemical element; it has Symbol (chemistry), symbol K (from Neo-Latin ) and atomic number19. It is a silvery white metal that is soft enough to easily cut with a knife. Potassium metal reacts rapidly with atmospheric oxygen to ...
levels are usually associated with hypomagnesemia. Low magnesium levels act to inhibit the sodium-potassium pump (Na-K-ATPase) which normally pumps sodium to the extracellular space and potassium into the intracellular space, using ATP as energy to pump both cations against their concentration gradient, to maintain relatively high levels of potassium in the intracellular compartment and high levels of sodium in the extracellular space. Hypomagnesemia also causes activation of the Renal outer medullary potassium channel (ROMK), a potassium channel that causes potassium losses in the urine via the cortical collecting duct in the kidney. And hypomagnesemia prevents low potassium levels from activating the sodium-chloride cotransporter (NCC) and downregulates NCC levels, which prevents sodium and chloride reabsorption from the kidney tubule. The inhibition of the sodium-potassium pump results in more potassium remaining in the extracellular space (interstitial fluid
In cell biology, extracellular fluid (ECF) denotes all body fluid outside the Cell (biology), cells of any multicellular organism. Body water, Total body water in healthy adults is about 50–60% (range 45 to 75%) of total body weight; women ...
and plasma). This potassium is then lost as blood is filtered in the kidney as ROMK channel activation causes potassium losses in the cortical collecting duct and NCC inhibition causes decreased sodium-chloride reabsorption by kidney tubules, with subsequent increased sodium-chloride (and water) delivery to the distal tubule, and associated diuresis and kaliuresis (kidney potassium loss in the urine). Overall, the net effect of low magnesium levels in the body is renal potassium losses (in the urine), thus clinically, low potassium levels are often refractory to supplementation without also correcting low magnesium levels.
Patients with diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally ...
should have their magnesium levels monitored to ensure that the serum loss of potassium, which is driven intracellularly by insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...
administration, is not exacerbated by additional urinary losses.
Calcium
Release of calcium
Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to it ...
from the sarcoplasmic reticulum is inhibited by magnesium. Thus hypomagnesemia results in an increased intracellular calcium level. This 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.
Arrhythmia
Magnesium is needed for the adequate function of the Na+/K+-ATPase pumps in cardiac myocytes, the muscles cells of the heart
The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...
. A lack of magnesium inhibits the reuptake of potassium, causing a decrease in intracellular potassium. This decrease in intracellular potassium results in tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...
.
Pre-eclampsia
Magnesium has an indirect antithrombotic effect on platelets and endothelial function. Magnesium increases prostaglandin
Prostaglandins (PG) are a group of physiology, physiologically active lipid compounds called eicosanoids that have diverse hormone-like effects in animals. Prostaglandins have been found in almost every Tissue (biology), tissue in humans and ot ...
s, decreases thromboxane, and decreases angiotensin II
Angiotensin is a peptide hormone that causes vasoconstriction and an increase in blood pressure. It is part of the renin–angiotensin system, which regulates blood pressure. Angiotensin also stimulates the release of aldosterone from the ...
, microvascular leakage and vasospasm through its function similar to calcium channel blocker
Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...
s. Convulsions are the result of cerebral vasospasm. The vasodilatory effect of magnesium seems to be the major mechanism.
Asthma
Magnesium exerts a bronchodilatatory effect, probably by antagonizing calcium-mediated bronchoconstriction.
Neurological effects
*Reducing electrical excitation,
*Modulating release of acetylcholine
Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...
,
*GABAA receptor
The GABAA receptor (GABAAR) is an ionotropic receptor and ligand-gated ion channel. Its endogenous Ligand (biochemistry), ligand is γ-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. Accurate regul ...
agonism,
*Antagonising ''N''-methyl-D-aspartate ( NMDA) glutamate
Glutamic acid (symbol Glu or E; known as glutamate in its anionic form) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is a Essential amino acid, non-essential nutrient for humans, meaning that ...
receptors, an excitatory neurotransmitter
A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a Chemical synapse, synapse. The cell receiving the signal, or target cell, may be another neuron, but could also be a gland or muscle cell.
Neurotra ...
of the central nervous system and thus providing neuroprotection from excitoxicity.
Diabetes mellitus
Magnesium deficiency is frequently observed in people with type 2 diabetes mellitus, with an estimated prevalence ranging between 11 and 48%. Magnesium deficiency is strongly associated with high glucose and insulin resistance, which indicate that it is common in poorly controlled diabetes. Patients with type 2 diabetes and a magnesium deficiency have a higher risk of heart failure, atrial fibrillation, and microvascular complications. Oral magnesium supplements has been demonstrated to improve insulin sensitivity and lipid profile. A 2016 meta-analysis not restricted to diabetic subjects found that increasing dietary magnesium intake, while associated with a reduced risk of stroke, heart failure, diabetes, and all-cause mortality, was not clearly associated with lower risk of coronary heart disease (CHD) or total cardiovascular disease (CVD).
Homeostasis
Magnesium-rich foods include cereals
A cereal is a grass cultivated for its edible grain. Cereals are the world's largest crops, and are therefore staple foods. They include rice, wheat, rye, oats, barley, millet, and maize (Corn). Edible grains from other plant families, suc ...
, green vegetables (with magnesium being a main component of chlorophyll
Chlorophyll is any of several related green pigments found in cyanobacteria and in the chloroplasts of algae and plants. Its name is derived from the Greek words (, "pale green") and (, "leaf"). Chlorophyll allows plants to absorb energy ...
), beans
A bean is the seed of some plants in the legume family (Fabaceae) used as a vegetable for human consumption or animal feed. The seeds are often preserved through drying (a ''pulse''), but fresh beans are also sold. Dried beans are tradition ...
, and nuts. It is absorbed primarily in the small intestine
The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...
via paracellular transport; passing between intestinal cells. Magnesium absorption in the large intestine
The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the Digestion, digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces befor ...
is mediated by the transporters TRPM6 and TRPM7.
The body contains about 25 grams of magnesium. Of the body's magnesium, 50-60% is stored in bone
A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
, with the remainder, about 40-50%, being stored in muscle or soft tissue, with about 1% being in the plasma. Therefore, normal plasma levels of magnesium may sometimes be seen despite a person being in a state of magnesium deficiency and plasma magnesium levels may underestimate the level of deficiency. Plasma magnesium levels may more accurately reflect magnesium stores when consideration is also given to urinary magnesium losses and oral magnesium intake.
Inside cells, 90-95% of magnesium is bound to ligands, including ATP, ADP, citrate, other proteins, and nucleic acids
Nucleic acids are large biomolecules that are crucial in all cells and viruses. They are composed of nucleotides, which are the monomer components: a 5-carbon sugar, a phosphate group and a nitrogenous base. The two main classes of nucleic a ...
. In the plasma, 30% of magnesium is bound to proteins via free fatty acids, therefore elevated levels of free fatty acids are associated with hypomagnesemia and a possible risk of cardiovascular disease.
The kidneys regulate magnesium levels by reabsorbing magnesium from the tubules. In the proximal tubule (at the beginning of the nephron
The nephron is the minute or microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and a cup-shaped structu ...
, the functional unit of the kidney) 20% of magnesium is reabsorbed via paracellular transport with claudin 2 and claudin 12 forming channels to allow for reabsorption. 70% of magnesium is reabsorbed in the thick ascending limb of the loop of Henle
In the kidney, the loop of Henle () (or Henle's loop, Henle loop, nephron loop or its Latin counterpart ''ansa nephroni'') is the portion of a nephron that leads from the proximal convoluted tubule to the distal convoluted tubule. Named after it ...
where claudins 16 and 19 form the channels to allow for reabsorption. In the distal convoluted tubule, 5-10% of magnesium is reabsorbed transcellularly (through the cells) via the transporters TRPM6 and TRPM7. Epidermal growth factor and insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...
activate TRPM6 and 7 and increase magnesium levels via increased renal reabsorption.
Diagnosis
Magnesium deficiency or depletion is a low total body level of magnesium; it is not easy to measure directly.[
]
Blood magnesium
Typically the diagnosis is based on finding hypomagnesemia, a low blood magnesium level, which often reflects low body magnesium; however, magnesium deficiency can be present without hypomagnesemia, and vice versa. A plasma magnesium concentration of less than 0.6 mmol/L (1.46 mg/dL) is considered to be hypomagnesemia; severe disease generally has a level of less than 0.5 mmol/L (1.25 mg/dL).
Electrocardiogram
The electrocardiogram (ECG) change may show a tachycardia with a prolonged QT interval. Other changes may include prolonged PR interval, ST segment depression, flipped T waves, and long QRS duration.[
]
Treatments
Treatment of magnesium deficiency depends on the degree of deficiency and the clinical effects. Replacement by mouth is appropriate for people with mild symptoms, while intravenous replacement is recommended for people with severe effects.
Numerous oral magnesium preparations are available. In two trials of magnesium oxide, one of the most common forms in magnesium dietary supplements because of its high magnesium content per weight, was less bioavailable than magnesium citrate, chloride, lactate, or aspartate. Amino-acid chelate was also less bioavailable.
Intravenous magnesium sulfate
Magnesium sulfate or magnesium sulphate is a chemical compound, a salt with the formula , consisting of magnesium cations (20.19% by mass) and sulfate anions . It is a white crystalline solid, soluble in water but not in ethanol.
Magnesi ...
(MgSO4) can be given in response to heart arrhythmias to correct for hypokalemia, preventing pre-eclampsia, and has been suggested as having potential use in asthma.[
]
Food
Food sources of magnesium include leafy green vegetables, beans, nuts, and seeds.
Epidemiology
Hypomagnesemia may be seen in 3-10% of the general population. It is present in an estimated 10-30% of people with diabetes, 10-60% of hospitalized people and greater than 65% of people in the ICU. In hospitalized patients, hypomagnesemia is associated with an increased length of stay. And in those in an ICU, it is associated with a higher risk of requiring mechanical ventilation
Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...
, and death. In population-based cohort studies, chronic magnesium deficiency was associated with an increased risk of cardiovascular death and overall death.
History
Magnesium deficiency in humans was first described in the medical literature in 1934.
Plants
Magnesium deficiency is a detrimental plant disorder that usually occurs in strongly acidic, light, sandy soils, where magnesium can be easily leached away. Magnesium is an essential macronutrient constituting 0.2-0.4% of plants' dry matter and is necessary for normal plant growth. Excess potassium, generally due to fertilizers, further aggravates the stress from magnesium deficiency, as does aluminium toxicity.
Magnesium has an important role in photosynthesis
Photosynthesis ( ) is a system of biological processes by which photosynthetic organisms, such as most plants, algae, and cyanobacteria, convert light energy, typically from sunlight, into the chemical energy necessary to fuel their metabo ...
because it forms the central atom of chlorophyll
Chlorophyll is any of several related green pigments found in cyanobacteria and in the chloroplasts of algae and plants. Its name is derived from the Greek words (, "pale green") and (, "leaf"). Chlorophyll allows plants to absorb energy ...
. Therefore, without sufficient amounts of magnesium, plants begin to degrade the chlorophyll in the old leaves. This causes the main symptom of magnesium deficiency, interveinal chlorosis
In botany, chlorosis is a condition in which leaves produce insufficient chlorophyll. As chlorophyll is responsible for the green color of leaves, chlorotic leaves are pale, yellow, or yellow-white. The affected plant has little or no ability to ...
, or yellowing between leaf veins, which stay green, giving the leaves a marbled appearance. Due to magnesium's mobile nature, the plant will first break down chlorophyll in older leaves and transport the Mg to younger leaves which have greater photosynthetic needs. Therefore, the first sign of magnesium deficiency is the chlorosis of old leaves which progresses to the young leaves as the deficiency progresses. Magnesium also acts as an activator for many critical enzymes, including ribulosebisphosphate carboxylase ( RuBisCO) and phosphoenolpyruvate carboxylase (PEPC), both essential enzymes in carbon fixation
Biological carbon fixation, or сarbon assimilation, is the Biological process, process by which living organisms convert Total inorganic carbon, inorganic carbon (particularly carbon dioxide, ) to Organic compound, organic compounds. These o ...
. Thus low amounts of Mg decrease photosynthetic and enzymatic activity within the plants. Magnesium is also crucial in stabilizing ribosome
Ribosomes () are molecular machine, macromolecular machines, found within all cell (biology), cells, that perform Translation (biology), biological protein synthesis (messenger RNA translation). Ribosomes link amino acids together in the order s ...
structures, hence, a lack of magnesium causes depolymerization of ribosomes leading to premature aging of the plant. After prolonged magnesium deficiency, necrosis
Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...
and dropping of older leaves occurs. Plants deficient in magnesium also produce smaller, woodier fruits.
Magnesium deficiency in plants may be confused with zinc
Zinc is a chemical element; it has symbol Zn and atomic number 30. It is a slightly brittle metal at room temperature and has a shiny-greyish appearance when oxidation is removed. It is the first element in group 12 (IIB) of the periodic tabl ...
or chlorine
Chlorine is a chemical element; it has Symbol (chemistry), symbol Cl and atomic number 17. The second-lightest of the halogens, it appears between fluorine and bromine in the periodic table and its properties are mostly intermediate between ...
deficiencies, viruses, or natural aging since all have similar symptoms. Adding Epsom salts (as a solution of 25 grams per liter or 4 oz per gal) or crushed dolomitic limestone to the soil can rectify magnesium deficiencies. An organic treatment is to apply compost
Compost is a mixture of ingredients used as plant fertilizer and to improve soil's physical, chemical, and biological properties. It is commonly prepared by Decomposition, decomposing plant and food waste, recycling organic materials, and man ...
mulch
A mulch is a layer of material applied to the surface of soil. Reasons for applying mulch include conservation of soil moisture, improving soil fertility, fertility and health of the soil, reducing Weed control, weed growth, and enhancing the v ...
, which can prevent leaching during excessive rainfall and provide plants with sufficient amounts of nutrients, including magnesium.
See also
* Magnesium in biology
* Hypermagnesemia, high level of magnesium in blood
References
External links
Magnesium
{{Authority control
Magnesium
Mineral deficiencies
Wikipedia medicine articles ready to translate