Magnesium basics

Wilhelm Jahnen-Dechent, Markus Ketteler, Wilhelm Jahnen-Dechent, Markus Ketteler

Abstract

As a cofactor in numerous enzymatic reactions, magnesium fulfils various intracellular physiological functions. Thus, imbalance in magnesium status-primarily hypomagnesaemia as it is seen more often than hypermagnesaemia-might result in unwanted neuromuscular, cardiac or nervous disorders. Measuring total serum magnesium is a feasible and affordable way to monitor changes in magnesium status, although it does not necessarily reflect total body magnesium content. The following review focuses on the natural occurrence of magnesium and its physiological function. The absorption and excretion of magnesium as well as hypo- and hypermagnesaemia will be addressed.

Keywords: hypermagnesaemia; hypomagnesaemia; magnesium; physicochemical properties; physiological function; regulation.

Figures

Fig. 1.
Fig. 1.
(A and B) Magnesium (top left) is surrounded by two hydration shells, whereas calcium (top right) has just one layer. If elements need to fit into a structure (transporter or membrane ‘pore’), calcium (below right) simply sheds its hydration shell and its dehydrated ion will fit. Magnesium (below left), on the other hand, first has to get rid of two layers, which is highly energy consuming (simplified model).
Fig. 2.
Fig. 2.
Hydroxyapatite crystal unit. Enamel apatite contains the lowest concentrations of carbonate and magnesium ions, and is rich in fluoride F. Dentin and bone have the highest levels of carbonate and magnesium ions, but have low fluoride content. Fluoride decreases solubility and increases chemical stability, carbonate, chloride and especially magnesium all increase solubility of the otherwise very insoluble mineral. Chemically the mineral comprises a highly substituted carbonated calcium hydroxyapatite (HAP). In the absence of exact compositional analysis the biogenic forms of this mineral are collectively alluded to as “bioapatite”. Ca, calcium; Na, sodium; Mg, magnesium; Sr, strontium; OH, hydroxide; Cl, chloride; F, fluoride; PO4, HPO4, phosphate; CO3, carbonate.
Fig. 3.
Fig. 3.
Total serum magnesium is present in three different states. Because of different measurement methods, results published for each state of serum magnesium vary considerably. Therefore, a range for every state is provided [, , –24]. For additional data, please see also Tables 1 and 2 in the article by Cunningham et al. [28] in this supplement.
Fig. 4.
Fig. 4.
Magnesium balance. Values as indicated based on [7]. The conversion factor from milligrams to millimole is 0.04113.

References

    1. Cotton FA, Wilkinson G. Weilheim, Germany: Chemie GmbH; 1967. Anorganische Chemie.
    1. Weast RC. Handbook of Chemistry and Physics. Boca Raton, FL: CRC Press; 1987.
    1. Hollemann AF, Wiberg E. Lehrbuch der anorganischen Chemie. Berlin, Germany: De Gruyter; 1964.
    1. Bodaker I, Sharon I, Suzuki MT, et al. Comparative community genomics in the Dead Sea: an increasingly extreme environment. ISME J. 2010;4:399–407.
    1. Maguire ME, Cowan JA. Magnesium chemistry and biochemistry. Biometals. 2002;15:203–210.
    1. Wacker W. Magnesium and Man. Cambridge, MA: Havard University Press; 1980. pp. 1–184.
    1. Elin RJ. Magnesium metabolism in health and disease. Dis Mon. 1988;34:161–218.
    1. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003;24:47–66.
    1. Feillet-Coudray C, Coudray C, Gueux E, et al. A new in vitro blood load test using a magnesium stable isotope for assessment of magnesium status. J Nutr. 2003;133:1220–1223.
    1. Saris NE, Mervaala E, Karppanen H, et al. An update on physiological, clinical and analytical aspects. Clin Chim Acta. 2000;294:1–26.
    1. Grubbs RD, Maguire ME. Magnesium as a regulatory cation: criteria and evaluation. Magnesium. 1987;6:113–127.
    1. Maguire ME. Magnesium: a regulated and regulatory cation. Met Ions Biol Syst. 1990;26:135–153.
    1. Walser M. Magnesium metabolism. Ergeb Physiol. 1967;59:185–296.
    1. Aikawa JK. Magnesium: Its Biological Significance. Boca Raton, FL: CRC Press; 1981.
    1. Fox C, Ramsoomair D, Carter C. Magnesium: its proven and potential clinical significance. South Med J. 2001;94:1195–1201.
    1. Lewellen TK, Nelp WB, Murano R, et al. Absolute measurement of total-body calcium by the Ar-37 method-preliminary results: concise communication. J Nucl Med. 1977;18:929–932.
    1. Elin RJ. Assessment of magnesium status for diagnosis and therapy. Magnes Res. 2010;23:194–198.
    1. Rude R. Magnesium disorders. In: Kokko J, Tannen R (eds) Fluids and electrolytes. Philadelphia, PA: W.B. Saunders Company, 1996, pp. 421–445.
    1. Alfrey AC, Miller NL. Bone magnesium pools in uremia. J Clin Invest. 1973;52:3019–3027.
    1. Kroll MH, Elin RJ. Relationships between magnesium and protein concentrations in serum. Clin Chem. 1985;31:244–246.
    1. Touyz RM. Magnesium in clinical medicine. Front Biosci. 2004;9:1278–1293.
    1. Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83:302–320.
    1. Speich M, Bousquet B, Nicolas G. Reference values for ionized, complexed, and protein-bound plasma magnesium in men and women. Clin Chem. 1981;27:246–248.
    1. Walser M. Ion association. VI. Interactions between calcium, magnesium, inorganic phosphate, citrate and protein in normal human plasma. J Clin Invest. 1961;40:723–730.
    1. Navarro-Gonzalez JF, Mora-Fernandez C, Garcia-Perez J. Clinical implications of disordered magnesium homeostasis in chronic renal failure and dialysis. Semin Dial. 2009;22:37–44.
    1. Wills MR, Lewin MR. Plasma calcium fractions and the protein-binding of calcium in normal subjects and in patients with hypercalcaemia and hypocalcaemia. J Clin Pathol. 1971;24:856–866.
    1. Keller H. Klinisch-chemische Labordiagnostik für die Praxis. Stuttgart, Germany: Georg Thieme; 1991. p. 222.
    1. Cunningham J, Rodríguez JM, Messa P. Magnesium in chronic kidney disease stages 3 and 4, and in dialysis patients. Clin Kidney J. 2012;5(Suppl 1):i39–i51.
    1. Shechter M, Merz CN, Paul-Labrador M, et al. Oral magnesium supplementation inhibits platelet-dependent thrombosis in patients with coronary artery disease. Am J Cardiol. 1999;84:152–156.
    1. Altura BM, Altura BT. New perspectives on the role of magnesium in the pathophysiology of the cardiovascular system. I. Clinical aspects. Magnesium. 1985;4:226–244.
    1. Reis MA, Reyes FG, Saad MJ, et al. Magnesium deficiency modulates the insulin signaling pathway in liver but not muscle of rats. J Nutr. 2000;130:133–138.
    1. Barbagallo M, Dominguez LJ. Magnesium metabolism in type 2 diabetes mellitus, metabolic syndrome and insulin resistance. Arch Biochem Biophys. 2007;458:40–47.
    1. Takaya J, Kaneko K. Small for gestational age and magnesium in cord blood platelets: intrauterine magnesium deficiency may induce metabolic syndrome in later life. J Pregnancy. 2011;2011:270474.
    1. Hunter DR, Haworth RA, Southard JH. Relationship between configuration, function, and permeability in calcium-treated mitochondria. J Biol Chem. 1976;251:5069–5077.
    1. Orrenius S, Zhivotovsky B, Nicotera P. Regulation of cell death: the calcium-apoptosis link. Nat Rev Mol Cell Biol. 2003;4:552–565.
    1. Reynolds JL, Joannides AJ, Skepper JN, et al. Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol. 2004;15:2857–2867.
    1. Geiger H, Wanner C. Magnesium in disease. Clin Kidney J. 2012;5(Suppl 1):i25–i38.
    1. Elliott DA, Rizack MA. Epinephrine and adrenocorticotropic hormone-stimulated magnesium accumulation in adipocytes and their plasma membranes. J Biol Chem. 1974;249:3985–3990.
    1. Page E, Polimeni PI. Magnesium exchange in rat ventricle. J Physiol. 1972;224:121–139.
    1. Polimeni PI, Page E. Magnesium in heart muscle. Circ Res. 1973;33:367–374.
    1. Rogers T, Mahan P. Exchange of radioactive magnesium in the rat. Proc Soc Exp Biol Med. 1959;100:235–239.
    1. Rogers T. Distribution of Magnesium in the Rat. Radioisotopes in Animal Nutrition and Physiology. Vienna, Austria: International Atomic Energy Commission; 1965. pp. 285–282.
    1. Avioli LV, Berman M. Mg28 kinetics in man. J Appl Physiol. 1966;21:1688–1694.
    1. Marx A, Neutra RR. Magnesium in drinking water and ischemic heart disease. Epidemiol Rev. 1997;19:258–272.
    1. Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr. 2003;133:2879–2882.
    1. Graham L, Caesar J, Burgen A. Gastrointestinal absorption and excretion of Mg28 in man. Metabolism. 1960;9:646–659.
    1. Kayne LH, Lee DB. Intestinal magnesium absorption. Miner Electrolyte Metab. 1993;19:210–217.
    1. de Baaij JHF, Hoenderop JGJ, Bindels RJM. Regulation of magnesium balance: lessons learned from human genetic disease. Clin Kidney J. 2012;5(Suppl 1):i15–i24.
    1. Dirks JH. The kidney and magnesium regulation. Kidney Int. 1983;23:771–777.
    1. Quamme GA, Dirks JH. The physiology of renal magnesium handling. Ren Physiol. 1986;9:257–269.
    1. Barnes BA, Cope O, Harrison T. Magnesium conservation in the human being on a low magnesium diet. J Clin Invest. 1958;37:430–440.
    1. Massry SG, Seelig MS. Hypomagnesemia and hypermagnesemia. Clin Nephrol. 1977;7:147–153.
    1. Elin RJ, Hosseini JM, Gill JR., Jr Erythrocyte and mononuclear blood cell magnesium concentrations are normal in hypomagnesemic patients with chronic renal magnesium wasting. J Am Coll Nutr. 1994;13:463–466.
    1. Martin BJ, Lyon TD, Walker W, et al. Mononuclear blood cell magnesium in older subjects: evaluation of its use in clinical practice. Ann Clin Biochem. 1993;30 (Pt 1): 23–27.
    1. Moller JB, Klaaborg KE, Alstrup P, et al. Magnesium content of the human heart. Scand J Thorac Cardiovasc Surg. 1991;25:155–158.
    1. Huijgen HJ, Sanders R, van Olden RW, et al. Intracellular and extracellular blood magnesium fractions in hemodialysis patients; is the ionized fraction a measure of magnesium excess? Clin Chem. 1998;44:639–648.
    1. Spiegel DM. Magnesium in chronic kidney disease: unanswered questions. Blood Purif. 2011;31:172–176.
    1. Bardicef M, Bardicef O, Sorokin Y, et al. Extracellular and intracellular magnesium depletion in pregnancy and gestational diabetes. Am J Obstet Gynecol. 1995;172:1009–1013.
    1. Young DS. Effects of Preanalytical Variables on Clinical Laboratory Tests. Washington, DC: AACC Press; 1997.
    1. Gonzalez-Revalderia J, Garcia-Bermejo S, Menchen-Herreros A, et al. Biological variation of Zn, Cu, and Mg in serum of healthy subjects. Clin Chem. 1990;36:2140–2141.
    1. Tietz NW. Clinical Guide to Laboratory Tests. Philadelphia, PA: WB Saunders; 1990.
    1. Maj-Zurawska M. Clinical findings on human blood with the KONE ISE for Mg2+ . Scand J Clin Lab Invest Suppl. 1994;217:69–76.
    1. Nicar MJ, Pak CY. Oral magnesium load test for the assessment of intestinal magnesium absorption. Application in control subjects, absorptive hypercalciuria, primary hyperparathyroidism, and hypoparathyroidism. Miner Electrolyte Metab. 1982;8:44–51.
    1. Cohen L, Laor A. Correlation between bone magnesium concentration and magnesium retention in the intravenous magnesium load test. Magnes Res. 1990;3:271–274.
    1. Rude RK. Magnesium metabolism and deficiency. Endocrinol Metab Clin North Am. 1993;22:377–395.
    1. Nadler JL, Rude RK. Disorders of magnesium metabolism. Endocrinol Metab Clin North Am. 1995;24:623–641.
    1. Hashizume N, Mori M. An analysis of hypermagnesemia and hypomagnesemia. Jpn J Med. 1990;29:368–372.
    1. Guerrero-Romero F, Tamez-Perez HE, Gonzalez-Gonzalez G, et al. Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial. Diabetes Metab. 2004;30:253–258.
    1. Wong ET, Rude RK, Singer FR, et al. A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol. 1983;79:348–352.
    1. Chernow B, Bamberger S, Stoiko M, et al. Hypomagnesemia in patients in postoperative intensive care. Chest. 1989;95:391–397.
    1. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia. Requested vs routine. JAMA. 1990;263:3063–3064.
    1. Ryzen E, Wagers PW, Singer FR, et al. Magnesium deficiency in a medical ICU population. Crit Care Med. 1985;13:19–21.
    1. Bernstein L. Improving Magnesium Absorption and Bioavailibility. Geriatric Times; 2002. 3.
    1. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med. 1987;82:38–47.
    1. Elliott C, Newman N, Madan A. Gentamicin effects on urinary electrolyte excretion in healthy subjects. Clin Pharmacol Ther. 2000;67:16–21.
    1. Wazny LD, Brophy DF. Amiloride for the prevention of amphotericin B-induced hypokalemia and hypomagnesemia. Ann Pharmacother. 2000;34:94–97.
    1. June CH, Thompson CB, Kennedy MS, et al. Correlation of hypomagnesemia with the onset of cyclosporine-associated hypertension in marrow transplant patients. Transplantation. 1986;41:47–51.
    1. Lote CJ, Thewles A, Wood JA, et al. The hypomagnesaemic action of FK506: urinary excretion of magnesium and calcium and the role of parathyroid hormone. Clin Sci (Lond) 2000;99:285–292.
    1. Lajer H, Daugaard G. Cisplatin and hypomagnesemia. Cancer Treat Rev. 1999;25:47–58.
    1. Tejpar S, Piessevaux H, Claes K, et al. Magnesium wasting associated with epidermal-growth-factor receptor-targeting antibodies in colorectal cancer: a prospective study. Lancet Oncol. 2007;8:387–394.
    1. Broeren MA, Geerdink EA, Vader HL, et al. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med. 2009;151:755–756.
    1. Otsuka M, Kanamori H, Sasaki S, et al. Torsades de pointes complicating pentamidine therapy of Pneumocystis carinii pneumonia in acute myelogenous leukemia. Intern Med. 1997;36:705–708.
    1. Huycke MM, Naguib MT, Stroemmel MM, et al. A double-blind placebo-controlled crossover trial of intravenous magnesium sulfate for foscarnet-induced ionized hypocalcemia and hypomagnesemia in patients with AIDS and cytomegalovirus infection. Antimicrob Agents Chemother. 2000;44:2143–2148.
    1. al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiologic and clinical overview. Am J Kidney Dis. 1994;24:737–752.
    1. Klein GL, Herndon DN. Magnesium deficit in major burns: role in hypoparathyroidism and end-organ parathyroid hormone resistance. Magnes Res. 1998;11:103–109.
    1. Aglio LS, Stanford GG, Maddi R, et al. Hypomagnesemia is common following cardiac surgery. J Cardiothorac Vasc Anesth. 1991;5:201–208.
    1. Kuller L, Farrier N, Caggiula A, et al. Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1985;122:1045–1059.
    1. Knoers NV. Inherited forms of renal hypomagnesemia: an update. Pediatr Nephrol. 2009;24:697–705.
    1. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum. 2001;44:1201–1209.
    1. Fung MC, Weintraub M, Bowen DL. Hypermagnesemia. Elderly over-the-counter drug users at risk. Arch Fam Med. 1995;4:718–723.
    1. Clark BA, Brown RS. Unsuspected morbid hypermagnesemia in elderly patients. Am J Nephrol. 1992;12:336–343.
    1. Kontani M, Hara A, Ohta S, et al. Hypermagnesemia induced by massive cathartic ingestion in an elderly woman without pre-existing renal dysfunction. Intern Med. 2005;44:448–452.
    1. Mordes JP, Wacker WE. Excess magnesium. Pharmacol Rev. 1978;29:273–300.
    1. Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Intern Med. 2006;45:207–210.
    1. Cao Z, Bideau R, Valdes R, Jr, et al. Acute hypermagnesemia and respiratory arrest following infusion of MgSO4 for tocolysis. Clin Chim Acta. 1999;285:191–193.
    1. Vissers RJ, Purssell R. Iatrogenic magnesium overdose: two case reports. J Emerg Med. 1996;14:187–191.
    1. Ali A, Walentik C, Mantych GJ, et al. Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics. 2003;112:e70–e72.
    1. Whang R, Whang DD. Update: mechanisms by which magnesium modulates intracellular potassium. J Am Coll Nutr. 1990;9:84–85.
    1. Escuela MP, Guerra M, Anon JM, et al. Total and ionized serum magnesium in critically ill patients. Intensive Care Med. 2005;31:151–156.
    1. Huey CG, Chan KM, Wong ET, et al. Los Angeles County-University of Southern California Medical Center clinical pathology case conference: extreme hypermagnesemia in a neonate. Clin Chem. 1995;41:615–618.
    1. Oren S, Rapoport J, Zlotnik M, et al. Extreme hypermagnesemia due to ingestion of Dead Sea water. Nephron. 1987;47:199–201.
    1. Porath A, Mosseri M, Harman I, et al. Dead Sea water poisoning. Ann Emerg Med. 1989;18:187–191.
    1. Topf JM, Murray PT. Hypomagnesemia and hypermagnesemia. Rev Endocr Metab Disord. 2003;4:195–206.
    1. Mathers TW, Beckstrand RL. Oral magnesium supplementation in adults with coronary heart disease or coronary heart disease risk. J Am Acad Nurse Pract. 2009;21:651–657.
    1. Fuentes JC, Salmon AA, Silver MA. Acute and chronic oral magnesium supplementation: effects on endothelial function, exercise capacity, and quality of life in patients with symptomatic heart failure. Congest Heart Fail. 2006;12:9–13.
    1. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385–e484.
    1. Krendel DA. Hypermagnesemia and neuromuscular transmission. Semin Neurol. 1990;10:42–45.
    1. Pritchard JA. The use of magnesium sulfate in preeclampsia-eclampsia. J Reprod Med. 1979;23:107–114.
    1. Turner JA. Diagnosis and management of pre-eclampsia: an update. Int J Womens Health. 2010;2:327–337.
    1. Golzarian J, Scott HW, Jr, Richards WO. Hypermagnesemia-induced paralytic ileus. Dig Dis Sci. 1994;39:1138–1142.
    1. Berns AS, Kollmeyer KR. Magnesium-induced bradycardia. Ann Intern Med. 1976;85:760–761.
    1. Yoshida A, Itoh Y, Nagaya K, et al. Prolonged relaxant effects of vecuronium in patients with deliberate hypermagnesemia: time for caution in cesarean section. J Anesth. 2006;20:33–35.
    1. ANZCA Guidelines. Management of pre-clampsia and eclampsia. 2011 .
    1. McLaughlin SA, McKinney PE. Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction. Ann Pharmacother. 1998;32:312–315.
    1. Jung GJ, Gil HW, Yang JO, et al. Severe hypermagnesemia causing quadriparesis in a CAPD patient. Perit Dial Int. 2008;28:206.
    1. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result of excessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23:570–572.
    1. Somjen G, Hilmy M, Stephen CR. Failure to anesthetize human subjects by intravenous administration of magnesium sulfate. J Pharmacol Exp Ther. 1966;154:652–659.
    1. Qureshi T, Melonakos TK. Acute hypermagnesemia after laxative use. Ann Emerg Med. 1996;28:552–555.
    1. Gerard SK, Hernandez C, Khayam-Bashi H. Extreme hypermagnesemia caused by an overdose of magnesium-containing cathartics. Ann Emerg Med. 1988;17:728–731.
    1. Smilkstein MJ, Smolinske SC, Kulig KW, et al. Severe hypermagnesemia due to multiple-dose cathartic therapy. West J Med. 1988;148:208–211.
    1. Rizzo MA, Fisher M, Lock JP. Hypermagnesemic pseudocoma. Arch Intern Med. 1993;153:1130–1132.
    1. Tofil NM, Benner KW, Winkler MK. Fatal hypermagnesemia caused by an Epsom salt enema: a case illustration. South Med J. 2005;98:253–256.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir