MARY P. GUERRERA, MD, College of Connecticut College of Drugs, Farmington, Connecticut
STELLA LUCIA VOLPE, PhD, College of Pennsylvania College of Nursing, Philadelphia, Pennsylvania
JUN JAMES MAO, MD, College of Pennsylvania College of Drugs, Philadelphia, Pennsylvania
Magnesium is the fourth most plentiful important mineral within the physique. It’s distributed roughly one half within the bone and one half within the muscle and different mushy tissues; lower than one p.c is within the blood.1 Research estimate that 75 p.c of Individuals don’t meet the really useful dietary allowance of magneisum,2 which has raised concern in regards to the well being results of magnesium deficiency. Life-style elements (e.g., poor vitamin, extra alcohol consumption), some medicines (e.g., diuretics), and decrease mineral content material in generally eaten meals (e.g., fruit, greens) have led to a rise in research evaluating the potential hyperlink of magnesium deficiency to plenty of various medical situations, and magnesium’s doable effectiveness in supplementation.3–5
Early indicators of magnesium deficiency embrace lack of urge for food, nausea, vomiting, fatigue, and weak spot. Individuals might expertise numbness, tingling, muscle contractions and cramps, seizures, persona adjustments, irregular coronary heart rhythms, and coronary spasms as magnesium ranges lower. Extreme deficiency might result in hypocalcemia and hypokalemia.1 Situations which will result in hypomagnesemia embrace poorly-controlled diabetes mellitus; persistent malabsorptive issues(e.g., Crohndisease, gluten-sensitive enteropathy, regional enteritis); treatment use (e.g., diuretics, antibiotics); alcoholism; and older age (e.g., decreased absorption of magnesium, elevated renal exertion).1
There are challenges in diagnosing magnesium deficiency due to its distribution within the physique. Magnesium is an intracellular cation and its blood concentrations might not precisely mirror magnesium standing.6 Nevertheless, reductions in regular serum magnesium concentrations (1.8 to 2.3 mg per dL [0.74 to 0.95 mmol per L]) signify deficiency. Subsequently, serum magnesium concentrations are particular, however not delicate, to magnesium deficiency.7 Magnesium homeostasis is expounded to calcium and potassium standing, and ought to be evaluated together with these two cations.7 There are different strategies to evaluate magnesium standing, however the serum stage is the most typical and sensible check within the scientific setting.8
Magnesium is a necessary mineral for optimum metabolic operate. Analysis has proven that the mineral content material of magnesium in meals sources is declining, and that magnesium depletion has been detected in individuals with some persistent illnesses. This has led to an elevated consciousness of correct magnesium consumption and its potential therapeutic function in plenty of medical situations. Research have proven the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, extreme bronchial asthma, and migraine. Different areas which have proven promising outcomes embrace reducing the chance of metabolic syndrome, enhancing glucose and insulin metabolism, relieving signs of dysmenorrhea, and assuaging leg cramps in ladies who’re pregnant. Using magnesium for constipation and dyspepsia are accepted as commonplace care regardless of restricted proof. Though it’s protected in chosen sufferers at acceptable dosages, magnesium might trigger opposed results or loss of life at excessive dosages. As a result of magnesium is excreted renally, it ought to be used with warning in sufferers with kidney illness. Meals sources of magnesium embrace inexperienced leafy greens, nuts, legumes, and complete grains.
A = constant, good-quality patient-oriented proof; B = inconsistent or limited-quality patient-oriented proof; C = consensus, disease-oriented proof, typical observe, professional opinion, or case collection. For details about the SORT proof score system, go to https://www.aafp.org/afpsort.xml.
A = constant, good-quality patient-oriented proof; B = inconsistent or limited-quality patient-oriented proof; C = consensus, disease-oriented proof, typical observe, professional opinion, or case collection. For details about the SORT proof score system, go to https://www.aafp.org/afpsort.xml.
Pharmacology
Magnesium is the second most plentiful intracellular divalent cation and is a cofactor for greater than 300 metabolic reactions within the physique.9,10 These processes embrace protein synthesis, mobile vitality manufacturing and storage, cell progress and replica, DNA and RNA synthesis, and stabilization of mitochondrial membranes.11–14 Magnesium is among the minerals answerable for managing bone metabolism, nerve transmission, cardiac excitability, neuromuscular conduction, muscular contraction, vasomotor tone, and blood stress.11–14 Magnesium additionally performs a major function in glucose and insulin metabolism, primarily by its impression on tyrosine kinase exercise, phosphorylase b kinase exercise, and glucose transporter protein exercise.15–19 Due to these important roles, magnesium ranges could also be affected by stressors to the physique, reminiscent of in sure illness states. Supplementation with magnesium might have therapeutic results in these conditions.
Makes use of and Effectiveness
Magnesium has been used for quite a few situations. The most typical indications are mentioned right here so as of most supported to least supported within the literature.
ECLAMPSIA AND PREECLAMPSIA
Magnesium sulfate (intravenous and intramuscular) has been proven to be comparatively efficient for treating eclampsia and preeclampsia, though it has been thought-about the usual of care for many years.20 In 2003, two Cochrane evaluations confirmed that magnesium use in sufferers with eclampsia was superior to that of phenytoin (Dilantin) and lytic cocktail,21,22 with one other research exhibiting magnesium to be more practical than nimodipine (Nimotop).23 A unique 2003 Cochrane evaluation confirmed that 1 to 2 g of intravenous magnesium sulfate per hour lowered the chance of eclampsia in sufferers with preeclampsia by multiple half.24 Using magnesium doesn’t seem to have dangerous results on the mom or toddler within the quick time period.25
ARRHYTHMIA
A well known use of intravenous magnesium is for correcting the unusual ventricular tachycardia of torsade de pointes.26 Outcomes of a meta-analysis recommend that 1.2 to 10 g of intravenous magnesium sulfate can also be a protected and efficient technique for the acute administration of fast atrial fibrillation.27 A six-week randomized, double-blind crossover trial confirmed that oral magnesium supplementation lowered the frequency of asymptomatic ventricular arrhythmia in sufferers with steady congestive coronary heart failure secondary to coronary artery illness.28
ASTHMA
A 2000 Cochrane evaluation of magnesium sulfate for exacerbations of acute bronchial asthma within the emergency division discovered that proof doesn’t assist routine use of intravenous magnesium in all sufferers with acute bronchial asthma; nevertheless, it seems protected and helpful for extreme acute bronchial asthma by enhancing peak expiratory circulation fee and compelled expiratory quantity in a single second.29 In a meta-analysis of acute bronchial asthma in kids, intravenous magnesium demonstrated possible profit in reasonable to extreme bronchial asthma at the side of commonplace bronchodilators and steroids30; nevertheless, a randomized managed trial confirmed that oral magnesium added no scientific profit to plain outpatient remedy for persistent steady bronchial asthma in adults.31 In a 2005 Cochrane evaluation of inhaled magnesium sulfate in acute bronchial asthma, nebulized magnesium along with a beta2 agonist had been proven to enhance pulmonary operate and pattern towards profit in fewer hospital admissions.32
HEADACHE
Research have discovered that sufferers with cluster complications and traditional or widespread migraine, particularly menstrual migraine, have low ranges of magnesium.33,34 A potential, multicenter, double-blind randomized research carried out in Germany confirmed {that a} single each day dosage of 600 mg oral trimagnesium dicitrate considerably lowered the frequency of migraine in contrast with placebo, whereas a decrease twice each day dosage was discovered ineffective.35,36 For acute therapy of migraine, intravenous magnesium sulfate confirmed a statistically vital enchancment within the therapy of all signs in sufferers with aura, or as an adjuvant remedy for related signs in sufferers with out aura.37
DYSPEPSIA
One other widespread situation with a number of self-treatment choices is dyspepsia, a key symptom of gastroesophageal reflux illness (GERD). Antacids are broadly used for dyspepsia; nevertheless, research evaluating antacids with histamine H2 receptor antagonists (H2 blockers) have been restricted. A randomized, double-blind, crossover research confirmed that on-demand therapy with the antacid hydrotalcite (aluminum hydroxide, magnesium hydroxide, carbonate, and water) was more practical than famotidine (Pepcid) or placebo.38 An editorial on these findings questioned the usual use of H2 blockers, and really useful shifting to extra individualized therapy of gentle or intermittent GERD.39
CONSTIPATION
Sufferers typically self-treat constipation with over-the-counter merchandise, reminiscent of magnesium hydroxide (Milk of Magnesia) or magnesium citrate. Nevertheless, there are few research demonstrating effectiveness, as proven in a scientific evaluation of persistent constipation.40 Regardless of this, many physicians and sufferers have discovered these therapies useful, which signifies {that a} lack of proof shouldn’t be essentially synonymous with a scarcity of impact.41
OTHER
Magnesium is related to sustaining or enhancing bone mineral density as a dietary element together with potassium, fruits, and greens, or as an oral complement.42,43 One research steered that adults 18 to 30 years of age with larger magnesium consumption have a decrease threat of growing metabolic syndrome.44 One other research demonstrated a optimistic affiliation between hypomagnesemia and metabolic syndrome in adults.45 A 2002 Cochrane evaluation confirmed that magnesium lactate or citrate twice a day was efficient for leg cramps in pregnant ladies.46 A 2001 Cochrane evaluation of three small trials confirmed that in sufferers with dysmenorrhea, magnesium was more practical than placebo for ache aid and the necessity for extra treatment was much less.47 Research have linked magnesium deficiency to myocardial infarction, congestive coronary heart failure, major hypertension, and angina pectoris,48 however proof remains to be restricted to advocate its use for these situations.
Contraindications, Hostile Results, and Interactions
Though oral magnesium supplementation is well-tolerated, magnesium may cause gastrointestinal signs, together with nausea, vomiting, and diarrhea.49 Overdose of magnesium might trigger thirst, hypotension, drowsiness, muscle weak spot, respiratory melancholy, cardiac arrhythmia, coma, and loss of life.49
Concomitant use of magnesium and urinary excretion–lowering medicine, reminiscent of calcitonin, glucagon (Glucagen), and potassium-sparing diuretics, might enhance serum magnesium ranges, as might doxercalciferol (Hectorol).50 Concomitant oral consumption of magnesium might affect the absorption of fluoroquinolones, aminoglycosides, bisphosphonates, calcium channel blockers, tetracyclines, and skeletal muscle relaxants. Due to this, concomitant use ought to be monitored or averted when doable.51
Moreover, as a result of magnesium is cleared renally, sufferers with renal insufficiency (creatinine clearance of lower than 30 mL per minute [0.50 mL per second]) could also be at elevated threat of coronary heart block or hypermagnesemia; subsequently, magnesium ranges ought to be monitored. As with every dietary complement, the standard of the product is necessary. Some magnesium merchandise had been discovered to comprise lead.52
Dosages
Oral magnesium supplementation is protected in adults when utilized in dosages under the higher consumption stage of 350 mg per day (elemental magnesium).51 Nevertheless, larger dosages have been studied and could also be used for particular medical issues. Desk 1 offers chosen meals sources of magnesium and the quantity of magnesium per serving1; there is no such thing as a higher consumption stage for dietary magnesium. Magnesium is protected in kids when utilized in dosages under the tolerable higher consumption stage of 65 mg per day for kids one to a few years of age, 110 mg per day for kids 4 to eight years of age, and 350 mg per day for kids older than eight years.8 Desk 2 lists some widespread kinds and dosages of magnesium.
Backside Line – “magnesium uses”
Magnesium is a necessary mineral with proof of effectiveness in treating eclampsia and preeclampsia, arrhythmia, extreme bronchial asthma, and migraine (Desk 3). The Nationwide Heart for Complementary and Various Drugs is presently investigating the function of magnesium supplementation in gentle to reasonable persistent bronchial asthma.53 There are few research to assist vast use of magnesium for treating constipation and dyspepsia. A few of the potential indications that require additional investigation embrace reducing the chance of metabolic syndrome, treating leg cramps in pregnant ladies, stopping osteoporosis, and assuaging dysmenorrhea. Prognosis of gentle to reasonable magnesium deficiency is difficult as a result of sufferers could also be asymptomatic, and typical diagnostic testing is particular however not delicate. Magnesium testing and supplementation ought to be thought-about in at-risk sufferers, particularly these on diuretics, with poor dietary consumption, or with malabsorptive states. Supplementation of magnesium ought to usually not exceed the age-adjusted tolerable higher consumption stage and ought to be used with warning in sufferers with kidney dysfunction or in these taking sure medicines.
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