Magnesium metabolism in health and disease
Tóm tắt
Magnesium (Mg) is the main intracellular divalent cation, and under basal conditions the small intestine absorbs 30–50% of its intake. Normal serum Mg ranges between 1.7–2.3 mg/dl (0.75–0.95 mmol/l), at any age. Even though eighty percent of serum Mg is filtered at the glomerulus, only 3% of it is finally excreted in the urine. Altered magnesium balance can be found in diabetes mellitus, chronic renal failure, nephrolithiasis, osteoporosis, aplastic osteopathy, and heart and vascular disease. Three physiopathologic mechanisms can induce Mg deficiency: reduced intestinal absorption, increased urinary losses, or intracellular shift of this cation. Intravenous or oral Mg repletion is the main treatment, and potassium-sparing diuretics may also induce renal Mg saving. Because the kidney has a very large capacity for Mg excretion, hypermagnesemia usually occurs in the setting of renal insufficiency and excessive Mg intake. Body excretion of Mg can be enhanced by use of saline diuresis, furosemide, or dialysis depending on the clinical situation.
Tài liệu tham khảo
Belorin Font E (2007) Magnesio. In: Ayus C, Caramelo C, Tejedor A (eds) Agua, electrolitos y equilibrio ácido-base. Panamericana, Buenos Aires, pp 293–294
Belorin Font E (2007) Hipomagnesemia e hipermagnesemia. In: Ayus C, Caramelo C, Tejedor A (eds) Agua, electrolitos y equilibrio ácido-base. Panamericana, Buenos Aires, pp 341–344
Kelepouris E, Agus Z (1998) Hypomagnesemia: renal magnesium handling. Semin nephrol 18:58–73
Rude R, Gruber H, Wei L, Frausto A, Mills B (2003) Magnesium deficiency: effect on bone and mineral metabolism in the mouse. Calcif Tissue Int. 72:32–41
Graham LA, Caesar JJ, Burgen ASV (1960) Gastrointestinal absorption and excretion of magnesium in man. Metabolism 9:646–659
Rude R (1996) Magnesium disorders. In: Kokko J, Tannen R (eds) Fluids and electrolytes. Saunders Company, W.B. Philadelphia, pp 421–445
Spiegel D (2007) The role of magnesium binders in chronic kidney disease. Semin dial 20(4):333–336
Yu A (2004) Renal transport of calcium, magnesium and phosphate. In: Brenner B (ed) Brenner & Rector’s The kidney. Saunders, Philadelphia, pp 535–571
Kaplan N, Palmer B, Sakhaee K, Gonzalez G (1999) Update on renal osteodystrophy: pathogenesis and clinical management. Am J Med Sci 317(4):251–260
Guyton A, Hall J (2002) Manual de Fisiología Médica. McGraw–Hill, Interamericana, Madrid
Wen SF, Evanson RL, Dirks JH (1970) Micropuncture study of renal magnesium transport in proximal and distal tubule of dog. Am J Physiol 219:570–576
Brunette MG, Vigneault N, Carriere S (1974) Micropuncture study of magnesium transport along the nephron in the young rat. Am J Physiol 227:891–896
Shareghi GR, Agus ZS (1982) Magnesium transport in the cortical thick ascending limb of Henle’s loop of the rabbit. J Clin invest 69:759–769
Riccardi D, Hall AE, Chattopadhyay N et al (1998) Localization of the extracellular calcium sensing protein in the rat kidney. Am J Physiol 274:F611–F622
Macías Núñez JF, Cameron S (2006) Renal function in the elderly. In: Cameron S (ed) Oxford textbook of clinical nephrology. Oxford University Press, Oxford
Musso CG, Macías Núñez JF (2008) Renal acidification, calcium, phosphate and magnesium. In: Macías Núñez JF, Cameron S, Oreopoulos D (eds) Renal ageing: health and disease. Springer, New York, pp 155–171
Quamme GA (1982) Effect of hypercalcemia on renal tubular handling of calcium and magnesium. Can J Physiol Pharmacol 60:1275–1280
Millane TA, Ward DE, Camm AJ (1992) Electrophysiology, pacing and arrhythmia. Clin Cardiol 15:103–108
Oster JR, Epstein M (1988) Management of magnesium depletion. Am J Nephrol 8:349–354
Braden GL, Germain MJ, Fitzgibbons JP (1985) Impaired potassium and magnesium homeostasis in acute tubulo-interstitial nephritis. Nephron 41:273–278
Mason J (1990) Renal side-effects of cyclosporine. Transplant proc 22:1280–1283
Rude RK (1993) Magnesium metabolism and deficiency. Endocrinol Metab Clin North Am 22:377–395
Eisenbud E, LoBue CC (1976) Hypocalcemia after therapeutic use of magnesium sulphate. Arch Intern Med 136:688–691
Navarro J, Oster JR, Gknosos PJ et al (1991) Tetany induced on separate occasions by administration of potassium and magnesium in a patient with hungry-bone syndrome. Miner Electrolyte Metab 17:340–344
Bundy JT, Connito D, Mahoney MD et al (1995) Treatment of idiopathic renal magnesium wasting with amiloride. Am J Nephrol 15:75–77
Devane J, Ryan MP (1981) The effects of amiloride and triamterene on urinary magnesium excretion in conscious saline-loaded rats. Br J Pharmacol 72:285–289
Christiansen C, Baastrup PC, Transbol L (1976) Lithium, hypercalcemia, hypermagnesemia, and hyperparathyroidism (letter). Lancet 2:969
Alfrey A (1996) Disorders of magnesium metabolism. In: Bennett JC, Plum F (eds) Cecil textbook of medicine. WB Saunders Company, Philadelphia, pp 1137–1138
Atabek M, Kurtoglu S, Pirgon O (2006) Possible effect of leptin on renal magnesium excretion in adolescent patients with type 1 diabetes. Pediatrics Int 48:393–397
Delfini E, Petramala L, Caliumi C, Cotesta D, De Toma G, Cavallaro G, Panzironi G, Diacinti D, Mimisola S, DÉrasmo E, Mazzuoli G, Letizia C (2007) Circulating leptin and adiponectin levels in patients with primary hyperparathyroidism. Metab Clin Exp 56:30–36
Massey L (2005) Magnesium therapy for nephrolithiasis. Magnes Res 18(2):123–126
Rude R, Gruber H, Norton J, Wei L, Frausto A, Kilbum J (2005) Dietary magnesium reduction to 25% of nutrient requirement disrupts boné and mineral metabolism in the rat. Bone 37:211–219
D’Hase P, Couttenye M, Lamberts L, Elseviers M, Goodman W, Schrooten I, Cabrera W, De Broe M (1999) Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients. Clin Chem 45(9):1548–1556
Ng A, Hercz G, Kandel R, Grynpas M (2004) Association between fluoride, magnesium, aluminium and bone quality in renal osteodystrophy. Bone 34:216–224
Ersoy F (2007) Osteoporosis in the elderly with chronic kidney disease. Int Urol Nephrol 39:321–331
Port F, Young E (1996) Fluids and electrolyte disorders in dialysis. In: Kokko J, Tannen R (eds) Fluids and electrolytes. Saunders Company, Philadelphia, pp 533–560
Feriani M, Catizone L, Fracasso A (2000) Peritoneal dialysis solutions and systems. In: Gokal R, Khanna R, Krediet R, Nolph K (eds) Textbook of peritoneal dialysis. Kluwer Academic Publishers, Dordrecht, pp 253–305
Navarro J, Mora C, Jiménez A, Ci B, Torres A, Macías M, García J (1999) Relationship between serum magnesium and parathyroid hormone levels in hemodialysis patients. Am J Kidney Dis 34(1):43–48
Alon I, Gorelik O, Berman S, Almoznino-Sarafian D, Shteinshnaider M, Weissgarten J, Modai D, Cohen N (2006) Intracellular magnesium in elderly patients with heart failure: effects of diabetes and renal dysfunction. J Trace Elem Med Biol 20:221–226
García-Casasola G, Sánchez-Hernández C, Luengo Pierrad P, Arenas González S, Bilbao Garay J, Zapatero Gaviria A (2004) Hipomagnesemia e insuficiencia cardíaca. Rev Clin Esp 1:43–47
Ceremuzynski L, Gebalska J, Wolk R, Makowska E (2000) Hipomagnesemia in Herat failure with ventricular arrhythmias. Beneficial effects of magnesium supplementation. J Int Med 247:78–86