Hypomagnesemia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Magnesium deficiency is not uncommon in hospitalized patients. Elevated levels of magnesium (hypermagnesemia), however, are nearly always iatrogenic. 10-20% of all hospital patients, and 60-65% of patient in the intensive care unit (ICU) have hypomagnesemia. Hypomagnesiemia is underdiagnosed, as testing for serum magnesium levels is not routine. Hypomagnesemia results in increased mortality.

Low levels of magnesium in your blood may mean either there is not enough magnesium in the diet, the intestines are not absorbing enough magnesium or the kidneys are excreting too much magnesium. Deficiencies may be due to the following conditions:

• Alcoholism. Hypomagnesemia occurs in 30% of alcohol abuse and 85% in delirium tremens, due to malnutrition and chronic diarrhoea. Alcohol stimulates renal excretion of magnesium, which is also increased because of alcoholic ketoacidosis, hypophosphatemia and hyperaldosteronism resulting from liver disease. Also hypomagnesemia is related to thiamine deficiency because magnesium is needed for transforming thiamine into thiamine pyrophosphate.
• Diuretic use (the most common cause of hypomagnesemia)
• Antibiotics (i.e. aminoglycosides, amphotericin, pentamidine, gentamicin, tobramycin, viomycin) block resorption in the loop of Henle. 30% of patients using these antibiotics have hypomagnesemia,
• Other drugs
  • Digitalis, displaces magnesium into the cell
  • adrenergics, displace magnesium into the cell
  • Cisplatin, stimulates renal excretion
  • Ciclosporin, stimulates renal excretion
  • caspofungin acetate
  • Dexlansoprazole, Losartan and Hydrochlorothiazide, Naproxen and esomeprazole magnesium, Omeprazole, Pantoprazole
• Excess calcium
• Increased levels of stress
• Excess saturated fats
• Excess coffee or tea intake
• Excess phosphoric or carbonic acids (soda pop)
• Insufficient water consumption
• Excess salt
• Excess sugar intake
• Insufficient selenium
• Insufficient vitamin D or sunlight exposure
• Insufficient vitamin B6
• Gastrointestinal causes: the distal tractus digestivus secretes high levels of magnesium. Therefore, secretory diarrhoea can cause hypomagnesemia. Thus, Crohn's disease, ulcerative colitis, Whipple's disease and coeliac sprue can all cause hypomagnesemia.
• Renal magnesium loss in Bartter's syndrome, postobstructive diuresis, diuretic phase of acute tubular necrosis (ATN) and kidney transplant
• Diabetes mellitus: 38% of diabetic outpatient clinic visits involve hypomagnesemia, probably through renal loss because of glycosuria or ketoaciduria.
• Acute myocardial infarction: within the first 48 hours after a heart-attack 80% of patients have hypomagnesemia. This could be the result of an intracellular shift because of an increase in catecholamines.
• Malabsorption
• Milk diet in infants
• Acute pancreatitis
• Hydrogen fluoride poisoning