What is hypomagnesemia, cause, symptoms, treatment

Hypomagnesemia is a disease in which the serum magnesium concentration is less than 0.75mmol/L due to insufficient magnesium intake, malabsorption, excessive loss and a variety of clinical diseases. The main clinical manifestations are muscle tremor, hand and foot cramps, anxiety, irritability, arrhythmia, etc. This disease generally cannot heal itself and should be actively treated by a doctor. Most patients have a good prognosis.

Whether medical insurance

Some medicines, consumables, and medical treatment items are covered by medical insurance. For specific reimbursement ratios, please consult the local hospital medical insurance center.

Hereditary: Not usually inherited

Department: Endocrinology, Emergency Department

Onset site: whole body

Common symptoms: Muscle tremors, tetany, anxiety, irritability, heart rhythm disturbances

Main causes: Mainly caused by insufficient magnesium intake or excessive excretion

Inspection items

Physical examination, serum magnesium, urinary magnesium excretion, intravenous magnesium stress test, electrocardiogram

Important Notice

Hypomagnesemia can cause serious complications such as suffocation. Patients should receive active treatment to avoid further development of the disease.

Epidemiology

Prone population

1. Those who fast for a long time, are hungry, have anorexia, or have not received magnesium supplementation during long-term intravenous nutrition.

2. People with severe diarrhea or long-term gastrointestinal decompression and drainage.

3. Pregnant women and infants may have a relative magnesium deficiency due to increased physiological needs.

Causes

There are many clinical causes of hypomagnesemia, which are mainly related to insufficient magnesium intake, diseases of various systems such as the digestive system and endocrine system, and iatrogenic operations. It is also seen in long-term insufficient magnesium intake, excessive magnesium loss such as nausea, vomiting, and excessive drainage, and renal factors such as renal tubular disease and long-term use of diuretics.

Basic Cause

1. Insufficient magnesium intake

The general diet is also rich in magnesium, so as long as you can eat normally, the body will not be deficient in magnesium. Malnutrition, long-term fasting, anorexia, and long-term intravenous nutrition without paying attention to magnesium supplementation can all lead to insufficient magnesium intake, and a small amount of magnesium continues to be excreted in the urine, so hypomagnesemia can occur.

2. Digestive system diseases

Extensive intestinal resection, intestinal fistula or bile fistula, diarrhea and long-term gastrointestinal decompression can all cause hypomagnesemia.

3. Endocrine diseases

Hypomagnesemia can be seen in hyperparathyroidism, hyperthyroidism, aldosteronism and diabetic acidosis.

4. Iatrogenic

Magnesium deficiency may occur when magnesium is not supplemented during long-term use of parenteral nutrition or when magnesium-free dialysate is used during hemodialysis.

5. Others

Magnesium, calcium and sodium are all reabsorbed by the kidneys. Any measures that increase urinary calcium and sodium excretion can also increase magnesium excretion through the kidneys, leading to hypomagnesemia.

Symptoms

Clinical manifestations of hypomagnesemia include anorexia, nausea, vomiting, lethargy, fatigue, personality changes, tetany, and tremors and fasciculations. Neurological signs, especially tetany, are related to the concomitant hypocalcemia and/or hypokalemia. Severe hypomagnesemia can lead to generalized tonic-clonic seizures, especially in children.Typical symptoms

1. Neuromuscular aspects

The early symptoms of magnesium deficiency are often anorexia, nausea, vomiting, weakness and apathy. As magnesium deficiency worsens, neuromuscular disorders and abnormal behavior occur. These symptoms can exist alone or simultaneously and are easily induced by sound, light and mechanical stimulation. Occasionally accompanied by fever, sweating, convulsions or coma. There may also be depression, delusions, apathy, restlessness, anxiety, agitation, hallucinations, confusion and loss of orientation.

2. Heart symptoms

Magnesium is an inhibitor of calcium. Magnesium deficiency can increase calcium ion influx and promote the occurrence of arrhythmias, such as frequent atrial or ventricular premature contractions, multifocal atrial tachycardia, ventricular tachycardia and ventricular fibrillation, and sudden cardiac death. Hypomagnesemia can easily induce heart failure or aggravate digitalis poisoning in patients with heart disease who have experienced heart failure. In addition, magnesium deficiency can aggravate ventricular arrhythmias caused by potassium deficiency.

3. Other symptoms

Magnesium deficiency can cause anemia, which is characterized by shortened red blood cell lifespan, increased reticulocytes and spherocytes, and hyperplasia of bone marrow red blood cells.

complication

1. Hypertension

Hypomagnesemia is prone to hypertension, mainly due to increased calcium content in vascular smooth muscle cells, which causes vasoconstriction and increased peripheral vascular resistance. In addition, low magnesium can also enhance the vasoconstriction effect of vasoconstrictors such as catecholamines, thereby causing increased blood pressure.

2. Coronary heart disease

Hypomagnesemia plays a certain role in the occurrence and development of coronary heart disease, and its main mechanism is myocardial cell metabolic disorder and coronary artery spasm.

3. Hypokalemia

The reabsorption of potassium by the ascending limb of the loop of Henle depends on an enzyme in the renal tubular epithelial cells. This enzyme requires magnesium ions for activation. Magnesium deficiency reduces enzyme activity, leading to decreased renal potassium conservation function.

4. Hypoglycemia

Magnesium deficiency reduces the activity of adenylate cyclase, leading to a decrease in the secretion of parathyroid hormone (PTH) by the parathyroid glands. At the same time, the target organs’ responsiveness to PTH is weakened, and intestinal calcium absorption, tubular calcium reabsorption, and bone calcium mobilization are all impaired, leading to a decrease in blood calcium concentration.

Medical treatment

Emergency (120) Indications

1. Sudden convulsions that cannot be relieved in the short term.

2. Difficulty breathing that cannot be relieved.

All of the above require urgent treatment, go to the emergency department in time, and call the emergency number if necessary.

Outpatient Indications

1. Repeated or persistent muscle weakness and spasms.

2. Accompanied by fever and profuse sweating.

3. Accompanied by depression, indifference, delusion, restlessness, anxiety, and confusion.

4. Other severe, persistent or progressive symptoms and signs occur.

All of the above require prompt medical consultation.

Department

1. In case of emergency, go to the emergency department immediately.

2. Those with stable conditions can go to the endocrinology department for treatment.

Medical preparation

1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.

2. The doctor may perform a physical examination. Please wear loose clothing to facilitate the examination.

3. If you have taken any medicine recently, you can record the name, usage and dosage of the medicine to facilitate communication with the doctor.

4. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.

5. Family members may accompany you to the clinic and they should prepare questions they want to ask.

Questions your doctor may ask

1. Do you have symptoms such as muscle tremors, hand and foot cramps, anxiety, irritability, arrhythmia, etc.? When did these symptoms appear?

2. Do you have experience or habit of fasting or long-term hunger?

3. Have you ever had similar symptoms before? What caused it?

4. Do you have any other discomfort?

5. Do you smoke or drink?

6. Have you taken any medicine on your own? What is the usage and dosage? Did it provide any relief?

7. Have you been to other hospitals? What tests and treatments have you received?

8. Do you have any other underlying diseases?

Questions Patients Can Ask

1. What is the cause of my symptoms? Are there other possible causes?

2. What tests do I need to take? How long does it take to get the test results?

3. Is my condition serious? Do I need to be hospitalized?

4. What treatments are available? Are there risks associated with these treatments?

5. How long will the treatment take? Can it be cured? Will it relapse?

6. Will my illness be contagious to others? What should I pay attention to in my daily life?

7. I have other diseases. Will it affect the treatment effect?

8. If medication is required, what are the usage, dosage, and precautions of the medication?

Examine

Estimated inspection

Patients should seek medical attention promptly when they experience muscle tremors, hand and foot cramps, anxiety, irritability, arrhythmia, etc. When seeking medical attention, the doctor will first ask about the medical history, and then conduct a physical examination to initially understand the patient’s health status. If hypomagnesemia is suspected, the patient will be advised to undergo serum magnesium measurement, urinary magnesium excretion measurement, intravenous magnesium load test, etc. to clarify the diagnosis, and an electrocardiogram will be performed if necessary to assess the condition.

Physical examination

The doctor will perform a careful physical examination on the patient. Patients with hypomagnesemia may experience carpal spasm, and sometimes ataxia (such as unsteady gait when walking), choroidal hyperactivity disorder, muscle tremor, spontaneous muscle contraction, muscle weakness and muscle atrophy.

Laboratory tests

1. Serum magnesium determination

Serum magnesium determination is the main test for diagnosing this disease. The patient’s serum magnesium concentration is generally less than 0.75mmol/L. Sometimes, even if the serum magnesium is above 0.75mmol/L, hypomagnesemia cannot be denied.

2. Determination of urinary magnesium excretion

It helps to determine the cause of hypomagnesemia. If the excretion volume increases, it indicates that it is caused by renal, endocrine and other factors.

3. Intravenous magnesium loading test

This test is helpful for diagnosis. Generally, 500ml of glucose solution containing 30mmol magnesium sulfate is intravenously dripped within 12 hours, and then urine is collected for 24 hours to measure urinary magnesium excretion. If >50% of magnesium is retained in the body, it is magnesium deficiency, and if <30%, magnesium deficiency can be ruled out. You can also drip 400ml of glucose solution containing 20mmol magnesium intravenously within 1~2 hours, collect urine for 16 hours to measure the magnesium content. If the urinary magnesium is about 20% of the input, it indicates magnesium deficiency; if it is 70% of the input, magnesium deficiency can be ruled out. This test should not be used in patients with renal insufficiency, cardiac conduction disorders or respiratory insufficiency.Other tests

Electrocardiogram

Some patients may experience arrhythmia, manifested by prolonged PR interval and QT interval.

Diagnosis Diagnostic principles

The diagnosis can be basically confirmed based on the patient’s medical history, typical symptoms (such as muscle tremor, hand and foot cramps), and laboratory test results (such as serum magnesium determination, urinary magnesium excretion determination, and intravenous magnesium loading test). During the diagnosis process, it should also be differentiated from suspected diseases such as dystonia.

Differential Diagnosis

1. Hypokalemia

Low blood potassium can cause muscle weakness, convulsions, cramps and other symptoms similar to hypomagnesemia, which can be differentiated through serum ion tests. In addition, if the symptoms do not improve after potassium supplementation, hypomagnesemia should be considered.

2. Dystonia

Dystonia is a movement disorder syndrome characterized by involuntary and persistent movements, which is similar to the symptoms of this disease. It can be differentiated from hypomagnesemia based on medical history and laboratory tests.

Treatment principles

The treatment principle of hypomagnesemia is to prevent and treat the primary disease to eliminate the cause of hypomagnesemia. At the same time, magnesium is supplemented, mostly with magnesium sulfate preparations. At the same time, attention should be paid to changes in blood pressure and renal function, as well as the presence of hypocalcemia and hypokalemia.

Acute treatment

1. For patients with crises such as convulsions and heart rhythm disorders, magnesium should be given intravenously immediately. It should be added to glucose or normal saline and dripped within 10 to 15 minutes. During the treatment, the electrocardiogram should be monitored and the blood magnesium should be measured repeatedly.

2. After the condition improves, magnesium should still be given at a certain dose per kilogram of body weight within 24 hours, by intravenous drip, or 10% magnesium sulfate by intramuscular injection. After the symptoms are controlled on the second day, magnesium can be given at a certain dose per kilogram of body weight within 24 hours, by intramuscular injection of 10% magnesium sulfate, 3 times a day. If oral administration is possible, oral magnesium gluconate should be used instead, 3 times a day.

Drug treatment

Magnesium supplements: Generally, magnesium oxide can be taken orally or magnesium sulfate can be injected intramuscularly, and the dosage can be reduced after 2-3 days of continuous use. For those with severe hypomagnesemia or those who cannot tolerate oral magnesium salts, magnesium sulfate can be applied intravenously or injected intramuscularly. For patients with magnesium deficiency and normal renal function, the amount of magnesium that should be supplemented is about twice the estimated amount of deficiency, because about 50% of the magnesium given will be excreted in the urine. Magnesium gluconate can be taken orally, 3 times a day for 3-4 days.

Related drugs

Magnesium sulfate, magnesium oxide, magnesium gluconate

Surgery

Hypomagnesemia generally does not require surgical treatment.

Treatment cycle

The treatment cycle is generally 2 to 5 days, and there may be individual differences due to factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution.

Treatment costs

There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.

Prognosis

General Prognosis

Hypomagnesemia often occurs together with many other diseases. After active treatment and magnesium supplementation as needed, the prognosis is good.

Hazards

The incidence of acute ischemic heart disease, congestive heart failure, and coronary heart disease in patients with hypomagnesemia is higher than normal, which poses long-term risks to the patient’s physical and mental health.

Self-healing

Generally, it cannot heal itself and requires active medical treatment.

Curative

With active treatment, it can usually be cured.

Cure rate

There is no large sample data research yet.

Daily

Good psychological care is of great significance to the recovery of the disease. Family members should pay more attention to and comfort the patients, so that they can actively cooperate with the treatment and build confidence in overcoming the disease. At the same time, they should follow the doctor’s advice on medication, develop good living habits, and have regular checkups to prevent the progression of the disease.

Psychological care

1. Psychological characteristics

Patients with hypomagnesemia may experience symptoms such as convulsions and heart rhythm disorders that affect their quality of life and may experience anxiety.

2. Nursing measures

(1) Family members’ understanding and attitude towards the disease have a great impact on the patient’s psychology. Family members should pay more attention to and care for the patient, actively communicate with the patient, understand the patient’s psychological state, and understand their pain. Use methods such as comfort and encouragement to reduce the patient’s psychological burden and tension. Use hints to guide the patient’s concept to change in the right direction. When the patient loses confidence or has concerns about the treatment effect, give the patient appropriate hints, such as suggesting that the patient takes medicine on time. Create a good emotional environment so that the patient can stay in a good mood and recover soon.

(2) Patients should maintain a good attitude, face the situation optimistically, and actively accept and cooperate with treatment.

Life Management

1. Pay attention to rest and combine work and rest.

2. Pregnant women and infants should supplement magnesium in time according to physiological needs.

3. When you are in good physical condition, you can exercise appropriately.

Diet

Scientific diet conditioning can accelerate the recovery of patients with hypomagnesemia. While actively cooperating with treatment, patients should pay attention to dietary care and develop good eating habits.

Dietary advice

1. Food should be diversified, avoid picky eating, and pay attention to supplementing a variety of nutrients.

2. It is advisable to supplement magnesium-rich foods in moderation, such as green leafy vegetables, rough grains, nuts, fruits, etc. Meat, starchy foods and milk should also be consumed as needed.

3. In addition to food, a small amount of magnesium can also be obtained from drinking water.

Dietary taboos

1. Do not fast, stop eating, or induce vomiting.

2. Do not drink excessive amounts of alcohol to avoid alcohol poisoning.

Prevention Precautions

The following measures can prevent this disease:

1. In daily life, you should prevent insufficient magnesium intake, develop good eating habits, and avoid long-term fasting, hunger, alcoholism, etc.

2. Actively treat other endocrine and digestive system diseases.Tip: This content is only for the popularization of medical knowledge and cannot replace professional diagnosis and treatment. Please read with caution and follow the doctor’s advice.