Hypomagnesemia symptoms - Hypomagnesemia pathophysiology

Hypomagnesemia symptoms

What are the symptoms of hypomagnesemia?

Hypomagnesemia is a condition of magnesium deficit with below normal levels (less than 0.7 mmol/L) of the mineral in the blood.
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The very early hypomagnesemia may be asymptomatic and minor symptoms like general weakness and lack of appetite may go unnoticed. Common symptoms of blood magnesium (Mg2+) deficiency include anorexia, nausea, muscle weakness, cramps, tremors, dyspnea, hypertension, palpitations, arrhythmia, anxiety, confusion, personality changes and convulsions. Severe untreated hypomagnesemia may cause acute cardiac arrhythmia and sudden cardiac arrest, pulmonary arrest and death.

The common causes of hypomagnesemia include, nutritional and metabolic disturbances, hypercalcemia, malnutrition, starvation, malabsorption, celiac disease, Crohn syndrome, ulcerative colitis, chronic diarrhea, polyuria, renal ailments, endocrine disturbances, alcoholism and certain medications. Hypomagnesemia may occur in conjunction with other electrolyte disturbances like hypoalbuminemia, hypophosphatemia and hypokalemia. Diagnosis is usually done by analyzing the total blood Mg2+ levels. Oral or intravenous magnesium supplementation is the standard treatment option.

Electrolyte disturbances in hypomagnesemia

Blood Mg2+ deficit has a direct effect on the calcium (Ca), potassium (K), and sodium (Na) channels. As Mg has inhibiting effect on the potassium channel efflux, hypomagnesemia may lead to increased potassium efflux from the body and cause hypokalaemia.

Mg2+ is an inhibitor of release of calcium from sarcoplasmic reticulum stores found in the myocytes.
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Sarcoplasmic reticulum plays a major role in the excitation-contraction coupling function of muscles. The blocking of the release of calcium can lead to cascading effects on parathyroid hormone release and hypocalcemia. Hypomagnesemia may affect bone turnover and with the concurrent onset of hypocalcemia, bone loss may occur.

Neuromuscular symptoms of hypomagnesemia

Hypomagnesemia affects the excitation-contraction coupling function of muscles. There is also lack of balance between irritating sodium and potassium ions and sedative calcium and magnesium ions. These malfunctions can trigger an increase in the excitability of muscles and nerves and vasospastic disorders.

Hypomagnesemia leads to numbness and tingling in arms and legs, convulsions, muscle cramps, muscle spasms and tremors, extensor plantar reflex, nystagmus (abnormal eye movements), epileptic fits and tetany. For the same reasons there is increase in reflexes (hyperreflexia) and muscle weakness. Bronchoconstriction is calcium-mediated. In hypomagnesemia, antagonizing the function of calcium, bronchodilation takes place with the relaxation of bronchial smooth muscle. Neurological manifestations include numbness, confusion, disorientation, irritability, insomnia, hallucinations, restlessness, psychosis, mood disorders, loss of interest, gloom, despondency, low spirits, aggression and depression.

Cardiovascular symptoms of hypomagnesemia

Blood Mg2+ depletion and the resultant hypomagnesemia can impair the sodium-potassium pump of cardiac cell membranes. There is increased loss of potassium from the cardiac cells and their action potential is shortened which may lead to cardiac arrhythmia and tachycardia. In ailments like coronary artery disease, arterial atherogenesis, arterial thrombogenesis, atherosclerosis and hypercholesterolemia one of the common denominator is hypomagnesemia.
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The decrease in serum levels of the mineral causes a decrease in its intracellular level. This leads to increased intracellular calcium content. The increased concentration of calcium (Ca2+ ions) within vascular smooth muscle cells activates actin-myosin contractile proteins leading to increase in vascular tone, vasoconstriction and total peripheral resistance. Thus hypomagnesemia results in hypertension. The administration of Magnesium supplement helps in controlling preeclampsia, a hypertensive syndrome of pregnancy.
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Lichodziejewska B et al in their study, "clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation", have concluded that low serum magnesium is suspected for the pathogenesis of the symptoms of mitral valve prolapse syndrome (MVP).
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References:
1.Assadi F. Hypomagnesemia: an evidence-based approach to clinical cases. Iran J Kidney Dis. 2010 Jan;4(1):13-9.
2.Dietary Supplement Fact Sheet. National Institutes of Health.
http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
3.Lichodziejewska B, Kłoś J, Rezler J, Grudzka K, Dłuzniewska M, Budaj A, Ceremuzyński L. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. Am J Cardiol. 1997 Mar 15;79(6):768-72.
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Current topic on nutritional health benefits: Hypomagnesemia symptoms.