LISTA ODOBRENIH ZDRAVSTVENIH IZJAVA – EFSA
Magnezijum
Magnezijum ima ulogu u procesu deobe ćelije.
Magnezijum doprinosi normalnoj psihološkoj funkciji
Magnezijum doprinosi održavanju normalnih kostiju
Magnezijum doprinosi održavanju normalnih zuba.
Magnezijum doprinosi ravnoteži elektrolita
Magnezijum doprinosi normalnoj sintezi proteina.
Magnezijum doprinosi smanjenju umora i iscrplјenosti.
Magnezijum doprinosi normalnom energetskom metabolizmu.
Magnezijum doprinosi normalnoj funkciji mišića.
Magnezijum doprinosi normalnom funkcionisanju nervnog sistema.
Kalijum
Kalijum doprinosi održavanju normalnog krvnog pritiska.
Kalijum doprinosi normalnoj funkciji mišića.
Kalijum doprinosi normalnom funkcionisanju nervnog sistema.
Cink
Cink doprinosi normalnom kiselinsko-baznom metabolizmu.
Cink doprinosi normalnoj sintezi DNK.
Cink ima ulogu u procesu deobe ćelija.
Cink doprinosi normalnoj sintezi proteina.
Cink doprinosi normalnom metabolizmu makronutrijenata.
Cink doprinosi normalnom metabolizmu uglјenih hidrata.
Cink doprinosi normalnoj funkciji imunog sistema.
Cink doprinosi normalnoj kognitivnoj funkciji.
Cink doprinosi normalnom metabolizmu masnih kiselina.
Cink doprinosi normalnom metabolizmu vitamina A.
Cink doprinosi održavanju normalnih kostiju.
Cink doprinosi održavanju normalne kose.
Cink doprinosi održavanju normalne kože.
Cink doprinosi održavanju normalnih noktiju.
Cink doprinosi održavanju normalnog vida.
Cink doprinosi normalnoj plodnosti i reprodukciji.
Cink doprinosi održavanju normalnog nivoa testosterona u krvi.
Cink doprinosi zaštiti ćelija od oksidativnog stresa.
Jod
Jod doprinosi normalnoj proizvodnji tiroidnih hormona i normalnoj funkciji štitaste žlezde.
Jod doprinosi normalnom funkcionisanju nervnog sistema.
Jod doprinosi normalnoj kognitivnoj funkciji.
Jod doprinosi održavanju normalnog energetskog metabolizma.
Jod doprinosi održavanju normalne kože.
Jod doprinosi normalnom rastu dece.

MINERALNI PREPARATI MAGNEZIJUM HLORIDA:

RASTVOR MAGNEZIJUM HLORIDA 40% (400 mg/ g).

Magnesii chloridum solutio 40% (Magnesium chloridum hexahydricum).

 

ATC:

A12CC01 – mineralni suplementi magnezijum hlorid,

B05XA11 – rastvori elektrolita,

V60AB – monokomponentni homeopatik,

V60B – antropozofik.

 

U skladu sa:

1) Eu. Ph. 8,  01.07.2015. monografijom: 0402 Magnesium chloridum hexahydricum  (Magnesium chloride hexahydrate)

2) Pharmacopée française 2002 ANSM: Magnesii chloridum hexahydricum ad praeparationes homoeopathicas

(MAGNESIA MURIATICA POUR PRÉPARATIONS HOMÉOPATHIQUES)

3) USP 29 (Magnesium Chloride).

 

Mineralni preparati u tečnom obliku (nerazblaženi ili razblaženi) za oralnu i lokalnu (topikalnu) upotrebu.

 

a) Magnesii chloridum solutio 40% (Magnesium chloride dilution 40%),

 

Sastav:

a) rastvor (DER 1:2,5), rastvarač sterilna voda (aqua sterilisata) ili visoko prečišćena – ultra čista voda (aqua valde purificata),.

Magnesium chloridum hexahydricum ispoljava mnogobrojna istražena dejstva.

Sadržaj: sadrži magnezijum hlorid p.a. (pro analysi – analitičke čistoće 99,9%)

Molecular formula: MgCl₂ x 6H₂O  Molecular weight 95.21 (anhydrous); 203.3 (hexahydrate)

 

a) Magnesii chloridum solutio 40%,  400 mg magnezijum hlorida/ grama rastvora (49 mmol – 196 mmol 100g rastvora),

b) sterilna voda (aqua sterilisata), ili ultračista voda (aqua valde purificata/ UPW-elektroprovodljivosti ispod 1 µS/cm).

 

Magnezijum se označava jedinicom miliekvivalent na litar (mEq/L) ili milimol po litru (mmol/L).

Ekvivalencije

Svaki gram magnezijum hlorida (heksahidrata ) sadreži ≈ 4.9 mmol magnezijuma i 9.8 mmol hlorida. Magnezijum hlorid (heksahidrat ) 8.36 g sadrži približno 1 g magnezijuma (1 g ≈ 0,11962 g Mg) .

 

Normalne vrednosti su :

odrasli: 0.66 – 1.07 mmol/L (1.6 – 2.6 mg/dL)

0.7-1 mmol/L (1,5 – 2 mEq/ L ; 1.7 – 2.4 mg/ dL)

Kritična vrednost : < 1,0 ;  > 4,9 mg/ dL.

 

Magnezijum je jedan od glavnih intracelularnih katjona. Za normalnu neuromuskularnu aktivnost potrebna je normalna koncentracija ekstracelularnog kalcijuma i magnezijuma.

Intracelularni magnezijum je važan kofaktor za razne enzime, transportere i nukleinske kiseline koje su neophodne za normalnu celularnu funkciju, replikaciju i energetski metabolizam.

 

Niska vrednost magnezijuma (< 0,65 mmol/L) u krvi može biti izazvana:

– gubitkom magnezijuma zbog dijareje, znojenja, povraćanja ili
– zbog nedovoljnog unosa magnezijuma hranom,
– gubitka magnezijuma zbog teških opekotina ili odvodnjavanja rane
– bolestima kao što su cistična fibroza, ciroza jetre, akutni pankreatitis, hipo i hipertiroidizam, hipoparatiroidizam,
– upotrebom lekova kao što su diuretici ili antibiotici,
– dobijanjem tečnosti IV putem bez dovoljno magnezijuma,
– alkoholizmom, hiperaldosteronizmom, dijabetičkom acidozom.
– velikim fizičkim naporima (planinari, biciklisti, drvoseče, …),
– trudnoćom.

 

Visoka vrednosti magnezijuma u krvi može biti izazvana:

– insuficijencijom bubrega,
– traumama kao što su opekotine, udesi ili operacije,
– nekontrolisanim dijabetesom,
– hiperparatiroidizam.

 

Indikacije:

Mineralni preparati su namenjeni poboljšanju opšteg stanja organizma kroz razna naučno dokazana dejstva.

Upotreba kod profilakse hipomagnezijemije i hipomagnezijemije, kod infarkta miokarda.

 

Indikacije za upotrebu su:

– neuromuskularna preosetljivost (tremor, trzanje mišića, tetanije, grčevi)
– kardiološki problemi (tahikardija, aritmija, fibrilacija komore, u EKG-u produženje KT)
– gastrointestinalni problemi (ulcerozni kolitis, morbus Chron, celijakija, sindrom kratkog creva)
– kontinuirana upotreba diuretika ili nefrotoksičnih lekova.

 

Ima jako dejstvo kod: hipomagnezijemije.

 

Upotrebljava se kao: izvor elektrolita, kod infarkta miokarda, poremećaja u radu jetre, probavnih smetnji, konstipacije, inkontinencije urina, poremećaja  mokrenja, kod problema sa prostatom, menstrualnih bolova, krvarenja, obilne vaginalne sekrecije, nervnih tegoba, , …

 

Doziranje i način primene:

individualno u zavisnosti od godina starosti i stanja organizma

Magnesii chloridum solutio  40%:

(40% = 478,48 mg/ g Mg²⁺)

2 g (32 kapi) podeljeno u 2 do 4 doze (8 kapi 4X ili 16 kapi 2X).

Mineralni  preparati MAGNEZIJUM HLORID HSS:

pojedinačna doza: 0,5-1 g, preporučena dnevna doza (PDD): 2 g.

Oralna (sat vremena pre obroka) i lokalna primena.

Upotreba na koži: aplicirati na obolelo mesto u tankom sloju ili obliku impregniranog zavoja, razblažiti pre upotrebe čistom vodom. Zbog specifičnog ukusa kod oralne upotrebe, preporučuje se upotreba sa sokom narandže ili sličnim.

Napraviti pauzu posle 4 nedelje neprekidne upotrebe.

Po preporukama, preparat postiže najbolje efekte pri upotrebi od 8 do 12 nedelja, duža upotreba je bezbedna uz pauze.

 

Oralno LD50 >7,5 g/ kg

 

Kontraindikacije:

preosetljivost na aktivne supstance,
preosetljivost na jedinjenja magnezijuma,
bubrežna insuficijencija (<D2), anurija, dehidracija, poremećaj u srčanoj provodljivosti, poremećaj elektrolita.

U većim koncentracijama nadražuje GIT, izaziva proliv, slabost, hiporefleksiju, respiratornu depresiju i komu, smetnje u kardiovaskularnom sistemu (hipotenzija).

Čuvanje: na tamnom, suvom i hladnom mestu do 20˚C, van domašaja dece i izlaganja EM zračenju, u dobro zatvorenoj originalnoj ambalaži.

Rok upotrebe: 5 godina, posle prvog otvaranja 6 meseci.

Pakovanje: 120 g, standardne farmaceutske braon bočice; 300 g, 600 g, 1200 g i 6000 g na zahtev.

 

Nutritivne informacije, MAGNEZIJUM HLORID HSS:

energetska vrednost u 100 g: 0 kJ/ 0 kcal (N/A),

u preporučenoj dnevnoj dozi (PDD) 2 g: 0kJ/ 0 (N/A),

suve materije (DR) više od

Magnesii chloridum solutio  40%.

40,0% (Fr. Ph.).

Bez konzervanasa, proteina, masti i ugljenih hidrata.

 

MAGNEZIJUM HLORID HSS su rukom rađeni proizvodi. 

Analizu na teške metale broj 146-353/06-15 od juna 2015. godine izvršila CH analitička laboratorija. ANALIZA MAGNEZIJUM HLORID p.a. 

CENOVNIK

	120 grama	120 grama
SPREJ 40%  RASTVOR	440,00 RSD	3,76 evra	sadrži 40 grama MgCl2 u 100 grama rastvora,
40%  RASTVOR	390,00 RSD	3,35 evra	sadrži 40 grama MgCl2 u 100 grama rastvora,
33%  RASTVOR	360,00 RSD	3,06 evra	sadrži 33 grama MgCl2 u 100 grama rastvora,
33 grama KRISTAL	140,00 RSD	1,15 evra	MgCl2 heksahidrat monokomponentni prah (kristal), p.a. (analitičke) čistoće,
100 grama KRISTAL	400,00 RSD	3,42 evra	MgCl2 heksahidrat monokomponentni prah (kristal), p.a. (analitičke) čistoće,
Sprej dozer	50,00 RSD	0,43 evra	dodatno za sve veličine bočica.

Podaci ažurirani oktobra 2020. Pogledati i ostale informacije na:

http://www.biljni-preparati.com/preparati/magnezijum-hlorid-magnesii-chloridum-hexahydricum-solutio/

ANALIZA MAGNEZIJUM HLORID p.a. 

MAGNESIUM
Dosage ADI=400-800 mg
(Davies, S., and Stewart, A. 1990. Nutritional Medicine. Avon Books, New York. 509pp.)
PTD=6,000 mg/day
RDA=40-400 mg/day
Total Plants: 538 Total Activities: 65

Activity:
Antiaggregant 400 mg/day
Antialcoholic
Antianginal 400 mg/day
Antianorectic
Antianxiety 400 mg/day
Antiarrhythmic 400 mg/day
Antiarthritic
Antiasthmatic
Antiatherosclerotic 400 mg/day
Anticephalagic
AntiCFS
Anticlimacteric 500-750 mg/day
Anticonvulsant
Anticoronary 400 mg/day
Antidepressant
Antidiabetic 400-800 mg/man/day
Antidysmenorrheic 100 mg 4 x/day
Antiendometriotic 500 mg/day
Antienterotic
Antiepileptic 450 mg/day
Antifatigue
Antifibromyalgic 200-300 mg 3x/day
Antigastrotic
Antiglaucomic
Antihyperkinetic
Antihypertensive
Antihypoglycemic
Antiinflammatory 100 mg 4 x/day
Antiinsomniac
Antilithic
AntiLyme 400-1,000 mg
Antimastalgic
Antimenopausal 500-750 mg/day
Antimigraine 200 mg/day/man
Antimitral-valve-prolapse
AntiMS
Antinephrolytic
Antineurotic
Antiosteoporotic 500-1,000 mg/day/wmn/orl
Antiplaque 500-1,000 mg/day
AntiPMS 400-800 mg/day/wmn/orl
AntiPMS 400-800 mg/day/wmn orl
AntiRaynaud’s 280-350 mg/day
Antiretinopathic 400 mg/day
Antispasmodic
Antispasmophilic 500 mg/day
Antistress 500-750 mg/day
Antistroke 400 mg/day
Antisyndrome-X 400 mg/man/day
Anxiolytic 500-750 mg/day
Calcium-Antagonist
Cardioprotective
CNS-Depressant
Diuretic
Hypocholesterolemic 400 mg/day
Hypotensive 260-500 mg/day
Immunomodulator
Insulinogenic 400 mg/day
Laxative 300-500 mg/day
Litholytic
Myorelaxant 100 mg 4 x/day
Neurotransmitter
Tranquilizer 500-750 mg/day
Uterorelaxant 100 mg 4 x/day
Vasodilator 

Reference:

Challem, J., Berkson, Burt, and Smith, Melissa Dianne. 2000. Syndrome X – The complete nutritional program to prevent and reservse insulin resistance. John Wiley & Sons, New York. 272 pp. $24.95

Davies, S., and Stewart, A. 1990. Nutritional Medicine. Avon Books, New York. 509pp.

Facciola, S. 1998. Cornucopia – A Source Book of Edible Plants. Kampong Publications, Vista CA. 713 pp.

Pizzorno, J.E. and Murray, M.T. 1985. A Textbook of Natural Medicine. John Bastyr College Publications, Seattle, Washington (Looseleaf).

Werbach, M. 1993. Healing with Food. Harper Collins, New York, 443 pp.

Magnesium chloratum Urtinktur D1 – 20 ml DHU

MAGNESIUM CHLORATUM TINCTURE D 1 20 ML

 

Magnesium Administration

Transdermal Magnesium Therapy

Magnesium Deficiency

Symptoms of Low Magnesium

For Healthcare Professionals

Uses

The following is a list of the primary uses of magnesium.

Asthma and Chronic Obstructive Pulmonary Disease (COPD): Magnesium helps to promote relaxation of the bronchial smooth muscles, thus opening the airways and easing breathing.

Cardiovascular Disease (CVD): Magnesium is essential for proper functioning of the entire cardiovascular system.

Acute myocardial infarction: People dying of heart attacks have lower magnesium levels than people of the same age dying of other causes. IV magnesium is a valued treatment for acute myocardial infarction.

The benefits of using magnesium are it:

– improves production within the heart;

– dilates the coronary arteries, which results in improved delivery of oxygen to the heart;

– reduces peripheral vascular resistance, which creates reduced demand on the heart;

– inhibits platelets from aggregating and forming blood clots;

– reduces the size of the infarct (blockage);

– improves heart rate andarrhythmias.

Angina: angina is caused be a spasming of a coronary artery and usually responds to magnesium supplementation. IV magnesium supplementation can also help with angina due to atherosclerosis by the same mechanisms as described above for myocardial infarctions.

Cardiac arrhythmia: The current understanding of why magnesium helps to treat arrhythmia is due to magnesium’s role in properpotassium levels. When these two electrolytes are out of balance or deficient, proper nerve and muscle firing cannot occur.

Cardiomyopathy: Several studies have shown that magnesium supplementation produces improvements in heart functioning for individuals with a variety of cardiomyopathies.

Congestive Heart Failure: is characterized by an energy depleted state and many CHF patients are deficient in both magnesium and Co Q10. Magnesium supplementation is also beneficial because many conventional treatments for CHF cause magnesium depletion.

High Blood Pressure: Population studies have shown a correlation between higher magnesium intake and lower blood pressure. Studies which have used magnesium as an intervention to treat high blood pressure show mixed results. Cases in which magnesium supplementation has been shown to be helpful is, first, when a patient is taking a diuretic which depletes magnesium. Second, when high blood pressure is associated with high renin output. Finally, magnesium may be helpful when a patient has elevated intracellular sodium or decreased intracellular potassium (measured by red blood cells studies). A 4 week trial of magnesium supplementation is often recommended to see if magnesium supplementation is beneficial.

Intermittent Claudication: is a peripheral vascular disease. Atherosclerosis causes this condition, and like coronary artery disease, peripheral vascular disease is also associated with a magnesium deficiency.

Low HDL Cholesterol Levels: Magnesium deficiency is associated with an increase in both LDL (bad) cholesterol and triglycerides and a decrease in HDL. *Mitral Valve Prolapse: Research has shown that 85% of patients with mitral valve prolapse have magnesium deficiency.

Prevention of Strokes and Transient Ischemic Attacks (TIAs): Blood vessels supplying the brain are particularly sensitive to magnesium status. Vascular spasming can result from magnesium deficiency and this spasming can sometimes cause strokes orTIAs. Supplementation with magnesium can cause relaxation in the vessels and improve blood flow to the brain. Magnesium can also protect against strokes just as it may reduce risk of heart attack.

Diabetes and Hypoglycemia: Magnesium plays a key role in the secretion and action of insulin. Without adequate magnesium levels, it is impossible for the body to properly control blood sugar levels. Magnesium may also helps to prevent diabetic sequelae such as retinopathy and heart disease. Diabetics may actually require more than the RDA for magnesium. Vitamin B6 is also critical for the transport of magnesium into cells and therefore must also be considered in a comprehensive treatment.

Eosinophilia-Myalgia Syndrome: This syndrome was first recognized in 1989 and in most cases is caused by contaminated L-tryptophan. It is characterized by early peripheral eosinophilia, severe muscle pain, inflammation, and in some cases neural and visceral involvement. It has been found that individuals with EMS have a selective decrease in skeletal muscle ATP concentration, possibly due to a magnesium deficiency (recall that magnesium plays a key role in ATP manufacturing). In preliminary studies, it appears that magnesium injections may be helpful in treating this disease.

Fatigue: Magnesium deficiency, even if subclinical, can lead to chronic fatigue syndrome. Studies have shown improvement of symptoms for individuals suffering from CFS with intramuscular injection of magnesium sulfate and also with oral magnesium andpotassium aspartate.

Fibromyalgia: Intracellular magnesium deficiency may be a contributing factor to fibromyalgia. One study shows that magnesium malate supplementation helps to improve the number and severity of tender points. Others suggest using magnesium chelated to the entire family of Kreb cycle intermediates.

Glaucoma: Magnesium supplementation has been shown to improve peripheral circulation and has benefited those suffering fromglaucoma in terms of improvements in visual fields.

Hearing Loss: There is an association between low magnesium and noise-induced hearing loss.

Kidney Stones: Magnesium increases the solubility of calcium in the urine, thereby preventing stone formation and also prevents recurrent stone formation. Concomitant use of vitamin B6 actually increases magnesium’s effectiveness even more. Magnesium citrate is the most effective form for this purpose.

Migraine and Tension Headaches: Due to magnesium’s role in blood vessel tone, magnesium deficiency is linked to tension andmigraine headaches. In fact, low levels of magnesium are found in the serum, saliva, and red blood cells of migraine sufferers. In addition, migraines are also linked to mitral valve prolapse. Changes in blood platelets which result from mitral valve prolapse cause the platelets to release substances that cause expansion in blood vessels in the head leading to migraines.

Osteoporosis: Calcium and magnesium go hand-in-hand in terms of their importance in treating and preventing osteoporosis. Women with osteoporosis have indicators of magnesium deficiency including low bone magnesium. In addition, the conversion of vitamin D to its more active form relies on adequate magnesium levels.

Pregnancy: One’s need for magnesium increases during pregnancy. Adequate magnesium during pregnancy is critical for the prevention of pre-eclampsia, pre-term delivery, and fetal growth retardation and supplementation decreases one’s risk of developing these conditions.

Premenstrual Syndrome and Dysmenorrhea: Red blood cell magnesium levels in those suffering from PMS symptoms are significantly lower than those who do not have PMS. Magnesium supplementation has shown beneficial effects in treating PMSsymptoms such as emotional instability, generalized aches and pains and lower premenstrual pain threshold. Effects are even greater when vitamin B6 and other nutrients are added to treatment.

Attention Deficit or Hyperactivity Disorder (ADD/ADHD): Symptoms of ADHD look a lot like symptoms of magnesium deficiency such as excessive fidgeting, anxious restlessness, psychomotor instability, and learning disabilities. In one study, 95% of the ADHD patients had magnesium deficiency when levels were measure in their serum, red blood cells, and hair. In another study, individuals who were supplemented with magnesium showed improvement in terms of hyperactivity compared to the control group.

Cancer: Magnesium is important in controlling growth of cells and may be helpful in treating cancer.

 

Deficiency Symptoms

Magnesium deficiency is common in the geriatric population as well as in women during the premenstrual period. Deficiency is often secondary to conditions that reduce absorption or increase secretion such as: high calcium intake, alcohol, surgery, diuretics, liver and kidney disease, and oral contraceptive pill use. Signs and symptoms of deficiency include:

-fatigue
-mental confusion
-irritability
-weakness
-heart disturbances
-problems in nerve conduction and muscle contraction
-muscle cramps
-loss of appetite
-insomnia
-predisposition to stress 

Excess Symptoms Magnesium excess is rare and is typically iatrogenic from IV magnesium, from laxatives or antacids containing magnesium, or intramuscular injections. Signs and symptoms of excess or toxicity may include:

-diarrhea (most common, does not occur with parenteral administration)
-drowsiness
-weakness
-lethargy
-nausea and vomiting
-hypotension
-urinary retention
-bradycardia
-respiratory depression
-depressed mental status
-electrocardiographic (ECG) abnormalities
-possibly death

Assessment Procedure Low serum magnesium reflects end-stage deficiency as most of the body’s magnesium concentrates in the cells and not in the serum. The best test to detect deficiency is the level of magnesium in the red blood cells.

Prescribing Considerations The different types of magnesium include magnesium oxide, gluconate, sulfate, chloride, and carbonate.

-Taking magnesium supplements with food is less likely to cause diarrhea.

-The recommended dosages varies based on age and health status. To determine what your specific requirements are talk to your naturopathic doctor or other trained medical professional.

-Infant: 40mg (under 6 months); 60mg (6-12 months)

-Child: 80mg (1-3 years); 120mg (4-6 years); 170mg (7-10 years)

-Adolescent: 270mg/ 280mg (Males/ Females 11-14 years);

400mg/ 300mg (Males/ Females 15-18 years)

-Adult: 350mg/ 280mg (Males/ Females 19+ years)

-Pregnancy: 320mg

-Lactation: 280mg

 

Safety

Children: No problems have been reported with normal intake in infants and children.

Pregnancy and Breastfeeding: No problems have been reported with normal intake during pregnancy and nursing.

Contraindications: individuals with impaired kidney function can accumulate magnesium (some medications such as aminoglycosides and amphotericin-B cause both renal tubular damage and magnesium depletion patterns); individuals with high-grade atrioventricular blocks or bifascicular blocks must avoid magnesium supplementation because it can slow cardiac conduction.

Precautions: Due to magnesium’s effect on blood sugar, for individuals with diabetes or hypoglycemia, it should be introduced slowly to prevent complications.

 

Nutrient Interactions

Nutrient Interactions include:

Alcohol – Hypomagnesemia is common in alcoholics due to increased renal excretion.

Calcium – High intake may decrease magnesium absorption.

Manganese – Concomitant magnesium use may be necessary during manganese supplementation.

Phosphate – High intake may decrease magnesium absorption. Separate intake by 2 hours.

Potassium – and magnesium deficiency often occur together and need to be treated concomitantly.

Vitamin B1 – One case report indicates that a patient developed cardiac beriberi with polyneuritis after protracted use of large amounts of magnesium trisilicate.

Vitamin B6 – is necessary for magnesium to enter cells. Using these two nutrients together may increase the therapeutic efficacy of magnesium supplementation.

Vitamin D – enhances the bioavailability of magnesium.

Zinc – supplementation may increase magnesium intake needs.

 

Resources

-Murray Michael T (2005) Encyclopedia of Nutritional Supplements, The Essential Guide for Improving Your Health Naturally, Prima Publishing.

-Hoffer Abram, Prousky Jonathan (2006) Naturopathic Nutrition, A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimum Health, CCNM Press

-Medlineplus

– Bralley J Alexander and Lord Richard S (2005) Laboratory Evaluations in Molecular Medicine, Nutrients, Toxicants, and Cell Regulators Institute for Advances in Molecular Medince, GA

-Stargrove Mitchell Bebell, Treasure Jonathan, McKee Dwight L (2008) Herb, Nutrient, and Drug Interactions, Clinical Implications and Therapeutic Strategies. Mosby

Izvor: www.ndhealthfacts.org

Magnesium

This is a fact sheet intended for health professionals. For a reader-friendly overview of Magnesium, see our consumer fact sheet on Magnesium.

Introduction

Magnesium, an abundant mineral in the body, is naturally present in many foods, added to other food products, available as a dietary supplement, and present in some medicines (such as antacids and laxatives). Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation [1-3]. Magnesium is required for energy production, oxidative phosphorylation, and glycolysis. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm [3].

An adult body contains approximately 25 g magnesium, with 50% to 60% present in the bones and most of the rest in soft tissues [4]. Less than 1% of total magnesium is in blood serum, and these levels are kept under tight control. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles (mmol)/L [1,5]. Hypomagnesemia is defined as a serum magnesium level less than 0.75 mmol/L [6]. Magnesium homeostasis is largely controlled by the kidney, which typically excretes about 120 mg magnesium into the urine each day [2]. Urinary excretion is reduced when magnesium status is low [1].

Assessing magnesium status is difficult because most magnesium is inside cells or in bone [3]. The most commonly used and readily available method for assessing magnesium status is measurement of serum magnesium concentration, even though serum levels have little correlation with total body magnesium levels or concentrations in specific tissues [6]. Other methods for assessing magnesium status include measuring magnesium concentrations in erythrocytes, saliva, and urine; measuring ionized magnesium concentrations in blood, plasma, or serum; and conducting a magnesium-loading (or “tolerance”) test. No single method is considered satisfactory [7]. Some experts [4] but not others [3] consider the tolerance test (in which urinary magnesium is measured after parenteral infusion of a dose of magnesium) to be the best method to assess magnesium status in adults. To comprehensively evaluate magnesium status, both laboratory tests and a clinical assessment might be required [6].

Recommended Intakes

Intake recommendations for magnesium and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences) [1]. DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and sex, include:

• Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
• Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
• Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
• Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects.

Table 1 lists the current RDAs for magnesium [1]. For infants from birth to 12 months, the FNB established an AI for magnesium that is equivalent to the mean intake of magnesium in healthy, breastfed infants, with added solid foods for ages 7–12 months.

Table 1: Recommended Dietary Allowances (RDAs) for Magnesium [1]

Age	Male	Female	Pregnancy	Lactation
Birth to 6 months	30 mg*	30 mg*
7–12 months	75 mg*	75 mg*
1–3 years	80 mg	80 mg
4–8 years	130 mg	130 mg
9–13 years	240 mg	240 mg
14–18 years	410 mg	360 mg	400 mg	360 mg
19–30 years	400 mg	310 mg	350 mg	310 mg
31–50 years	420 mg	320 mg	360 mg	320 mg
51+ years	420 mg	320 mg

*Adequate Intake (AI)

Sources of Magnesium

Food

Magnesium is widely distributed in plant and animal foods and in beverages. Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains, are good sources [1,3]. In general, foods containing dietary fiber provide magnesium. Magnesium is also added to some breakfast cereals and other fortified foods. Some types of food processing, such as refining grains in ways that remove the nutrient-rich germ and bran, lower magnesium content substantially [1]. Selected food sources of magnesium are listed in Table 2.

Tap, mineral, and bottled waters can also be sources of magnesium, but the amount of magnesium in water varies by source and brand (ranging from 1 mg/L to more than 120 mg/L) [8].

Approximately 30% to 40% of the dietary magnesium consumed is typically absorbed by the body [2,9].

Table 2: Selected Food Sources of Magnesium [10]

Food	Milligrams (mg) per serving	Percent DV*
Pumpkin seeds, roasted, 1 ounce	156	37
Chia seeds, 1 ounce	111	26
Almonds, dry roasted, 1 ounce	80	19
Spinach, boiled, ½ cup	78	19
Cashews, dry roasted, 1 ounce	74	18
Peanuts, oil roasted, ¼ cup	63	15
Cereal, shredded wheat, 2 large biscuits	61	15
Soymilk, plain or vanilla, 1 cup	61	15
Black beans, cooked, ½ cup	60	14
Edamame, shelled, cooked, ½ cup	50	12
Peanut butter, smooth, 2 tablespoons	49	12
Potato, baked with skin, 3.5 ounces	43	10
Rice, brown, cooked, ½ cup	42	10
Yogurt, plain, low fat, 8 ounces	42	10
Breakfast cereals, fortified with 10% of the DV for magnesium, 1 serving	42	10
Oatmeal, instant, 1 packet	36	9
Kidney beans, canned, ½ cup	35	8
Banana, 1 medium	32	8
Salmon, Atlantic, farmed, cooked, 3 ounces	26	6
Milk, 1 cup	24–27	6
Halibut, cooked, 3 ounces	24	6
Raisins, ½ cup	23	5
Bread, whole wheat, 1 slice	23	5
Avocado, cubed, ½ cup	22	5
Chicken breast, roasted, 3 ounces	22	5
Beef, ground, 90% lean, pan broiled, 3 ounces	20	5
Broccoli, chopped and cooked, ½ cup	12	3
Rice, white, cooked, ½ cup	10	2
Apple, 1 medium	9	2
Carrot, raw, 1 medium	7	2

*DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for magnesium on the new Nutrition Facts and Supplement Facts labels and used for the values in Table 2 is 420 mg for adults and children aged 4 years and older [12]. FDA required manufacturers to use these new labels starting in January 2020, but companies with annual sales of less than $10 million may continue to use the old labels that list a magnesium DV of 400 mg until January 2021 [11,13]. FDA does not require food labels to list magnesium content unless magnesium has been added to the food. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

The U.S. Department of Agriculture’s (USDA’s) FoodData Central [10] lists the nutrient content of many foods and provides comprehensive list of foods containing magnesium arranged by nutrient content and by food name.

Dietary supplements

Magnesium supplements are available in a variety of forms, including magnesium oxide, citrate, and chloride [2,3]. The Supplement Facts panel on a dietary supplement label declares the amount of elemental magnesium in the product, not the weight of the entire magnesium-containing compound.

Absorption of magnesium from different kinds of magnesium supplements varies. Forms of magnesium that dissolve well in liquid are more completely absorbed in the gut than less soluble forms [2,14]. Small studies have found that magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate [14-18]. One study found that very high doses of zinc from supplements (142 mg/day) can interfere with magnesium absorption and disrupt the magnesium balance in the body [19].

Medicines

Magnesium is a primary ingredient in some laxatives [20]. Phillips’ Milk of Magnesia®, for example, provides 500 mg elemental magnesium (as magnesium hydroxide) per tablespoon; the directions advise taking up to 4 tablespoons/day for adolescents and adults [21]. (Although such a dose of magnesium is well above the safe upper level, some of the magnesium is not absorbed because of the medication’s laxative effect.) Magnesium is also included in some remedies for heartburn and upset stomach due to acid indigestion [20]. Extra-strength Rolaids®, for example, provides 55 mg elemental magnesium (as magnesium hydroxide) per tablet [22], although Tums® is magnesium free [23].

Magnesium Intakes and Status

Dietary surveys of people in the United States consistently show that many people consume less than recommended amounts of magnesium. An analysis of data from the National Health and Nutrition Examination Survey (NHANES) of 2013-2016 found that 48% of Americans of all ages ingest less magnesium from food and beverages than their respective EARs; adult men aged 71 years and older and adolescent males and females are most likely to have low intakes [24]. In a study using data from NHANES 2003–2006 to assess mineral intakes among adults, average intakes of magnesium from food alone were higher among users of dietary supplements (350 mg for men and 267 mg for women, equal to or slightly exceeding their respective EARs) than among nonusers (268 mg for men and 234 for women) [25]. When supplements were included, average total intakes of magnesium were 449 mg for men and 387 mg for women, well above EAR levels.

No current data on magnesium status in the United States are available. Determining dietary intake of magnesium is the usual proxy for assessing magnesium status. NHANES has not determined serum magnesium levels in its participants since 1974 [26], and magnesium is not evaluated in routine electrolyte testing in hospitals and clinics [2].

Magnesium Deficiency

Symptomatic magnesium deficiency due to low dietary intake in otherwise-healthy people is uncommon because the kidneys limit urinary excretion of this mineral [3]. However, habitually low intakes or excessive losses of magnesium due to certain health conditions, chronic alcoholism, and/or the use of certain medications can lead to magnesium deficiency.

Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur [1,2]. Severe magnesium deficiency can result in hypocalcemia or hypokalemia (low serum calcium or potassium levels, respectively) because mineral homeostasis is disrupted [2].

Groups at Risk of Magnesium Inadequacy

Magnesium inadequacy can occur when intakes fall below the RDA but are above the amount required to prevent overt deficiency. The following groups are more likely than others to be at risk of magnesium inadequacy because they typically consume insufficient amounts or they have medical conditions (or take medications) that reduce magnesium absorption from the gut or increase losses from the body.

People with gastrointestinal diseases

The chronic diarrhea and fat malabsorption resulting from Crohn’s disease, gluten-sensitive enteropathy (celiac disease), and regional enteritis can lead to magnesium depletion over time [2]. Resection or bypass of the small intestine, especially the ileum, typically leads to malabsorption and magnesium loss [2].

People with type 2 diabetes

Magnesium deficits and increased urinary magnesium excretion can occur in people with insulin resistance and/or type 2 diabetes [27,28]. The magnesium loss appears to be secondary to higher concentrations of glucose in the kidney that increase urine output [2].

People with alcohol dependence

Magnesium deficiency is common in people with chronic alcoholism [2]. In these individuals, poor dietary intake and nutritional status; gastrointestinal problems, including vomiting, diarrhea, and steatorrhea (fatty stools) resulting from pancreatitis; renal dysfunction with excess excretion of magnesium into the urine; phosphate depletion; vitamin D deficiency; acute alcoholic ketoacidosis; and hyperaldosteronism secondary to liver disease can all contribute to decreased magnesium status [2,29].

Older adults

Older adults have lower dietary intakes of magnesium than younger adults [23,30]. In addition, magnesium absorption from the gut decreases and renal magnesium excretion increases with age [31]. Older adults are also more likely to have chronic diseases or take medications that alter magnesium status, which can increase their risk of magnesium depletion [1,32].

Magnesium and Health

Habitually low intakes of magnesium induce changes in biochemical pathways that can increase the risk of illness over time. This section focuses on four diseases and disorders in which magnesium might be involved: hypertension and cardiovascular disease, type 2 diabetes, osteoporosis, and migraine headaches.

Hypertension and cardiovascular disease

Hypertension is a major risk factor for heart disease and stroke. Studies to date, however, have found that magnesium supplementation lowers blood pressure, at best, to only a small extent. A meta-analysis of 12 clinical trials found that magnesium supplementation for 8–26 weeks in 545 hypertensive participants resulted in only a small reduction (2.2 mmHg) in diastolic blood pressure [33]. The dose of magnesium ranged from approximately 243 to 973 mg/day. The authors of another meta-analysis of 22 studies with 1,173 normotensive and hypertensive adults concluded that magnesium supplementation for 3–24 weeks decreased systolic blood pressure by 3–4 mmHg and diastolic blood pressure by 2–3 mmHg [34]. The effects were somewhat larger when supplemental magnesium intakes of the participants in the nine crossover-design trials exceeded 370 mg/day. A diet containing more magnesium because of added fruits and vegetables, more low-fat or non-fat dairy products, and less fat overall was shown to lower systolic and diastolic blood pressure by an average of 5.5 and 3.0 mmHg, respectively [35]. However, this Dietary Approaches to Stop Hypertension (DASH) diet also increases intakes of other nutrients, such as potassium and calcium, that are associated with reductions in blood pressure, so any independent contribution of magnesium cannot be determined.

Several prospective studies have examined associations between magnesium intakes and heart disease. The Atherosclerosis Risk in Communities study assessed heart disease risk factors and levels of serum magnesium in a cohort of 14,232 white and African-American men and women aged 45 to 64 years at baseline [36]. Over an average of 12 years of follow-up, individuals in the highest quartile of the normal physiologic range of serum magnesium (at least 0.88 mmol/L) had a 38% reduced risk of sudden cardiac death compared with individuals in the lowest quartile (0.75 mmol/L or less). However, dietary magnesium intakes had no association with risk of sudden cardiac death. Another prospective study tracked 88,375 female nurses in the United States to determine whether serum magnesium levels measured early in the study and magnesium intakes from food and supplements assessed every 2 to 4 years were associated with sudden cardiac death over 26 years of follow-up [37]. Women in the highest compared with the lowest quartile of ingested and plasma magnesium concentrations had a 34% and 77% lower risk of sudden cardiac death, respectively. Another prospective population study of 7,664 adults aged 20 to 75 years in the Netherlands who did not have cardiovascular disease found that low urinary magnesium excretion levels (a marker for low dietary magnesium intake) were associated with a higher risk of ischemic heart disease over a median follow-up period of 10.5 years. Plasma magnesium concentrations were not associated with risk of ischemic heart disease [38]. A systematic review and meta-analysis of prospective studies found that higher serum levels of magnesium were significantly associated with a lower risk of cardiovascular disease, and higher dietary magnesium intakes (up to approximately 250 mg/day) were associated with a significantly lower risk of ischemic heart disease caused by a reduced blood supply to the heart muscle [39].

Higher magnesium intakes might reduce the risk of stroke. In a meta-analysis of 7 prospective trials with a total of 241,378 participants, an additional 100 mg/day magnesium in the diet was associated with an 8% decreased risk of total stroke, especially ischemic rather than hemorrhagic stroke [40]. One limitation of such observational studies, however, is the possibility of confounding with other nutrients or dietary components that could also affect the risk of stroke.

A large, well-designed clinical trial is needed to better understand the contributions of magnesium from food and dietary supplements to heart health and the primary prevention of cardiovascular disease [41].

Type 2 diabetes

Diets with higher amounts of magnesium are associated with a significantly lower risk of diabetes, possibly because of the important role of magnesium in glucose metabolism [42,43]. Hypomagnesemia might worsen insulin resistance, a condition that often precedes diabetes, or it might be a consequence of insulin resistance [44]. Diabetes leads to increased urinary losses of magnesium, and the subsequent magnesium inadequacy might impair insulin secretion and action, thereby worsening diabetes control [3].

Most investigations of magnesium intake and risk of type 2 diabetes have been prospective cohort studies. A meta-analysis of 7 of these studies, which included 286,668 patients and 10,912 cases of diabetes over 6 to 17 years of follow-up, found that a 100 mg/day increase in total magnesium intake decreased the risk of diabetes by a statistically significant 15% [42]. Another meta-analysis of 8 prospective cohort studies that followed 271,869 men and women over 4 to 18 years found a significant inverse association between magnesium intake from food and risk of type 2 diabetes; the relative risk reduction was 23% when the highest to lowest intakes were compared [45].

A 2011 meta-analysis of prospective cohort studies of the association between magnesium intake and risk of type 2 diabetes included 13 studies with a total of 536,318 participants and 24,516 cases of diabetes [46]. The mean length of follow-up ranged from 4 to 20 years. Investigators found an inverse association between magnesium intake and risk of type 2 diabetes in a dose-responsive fashion, but this association achieved statistical significance only in overweight (body mass index [BMI] 25 or higher) but not normal-weight individuals (BMI less than 25). Again, a limitation of these observational studies is the possibility of confounding with other dietary components or lifestyle or environmental variables that are correlated with magnesium intake.

Only a few small, short-term clinical trials have examined the potential effects of supplemental magnesium on control of type 2 diabetes and the results are conflicting [43,47]. For example, 128 patients with poorly controlled diabetes in a Brazilian clinical trial received a placebo or a supplement containing either 500 mg/day or 1,000 mg/day magnesium oxide (providing 300 or 600 mg elemental magnesium, respectively) [48]. After 30 days of supplementation, plasma, cellular, and urine magnesium levels increased in participants receiving the larger dose of the supplement, and their glycemic control improved. In another small trial in Mexico, participants with type 2 diabetes and hypomagnesemia who received a liquid supplement of magnesium chloride (providing 300 mg/day elemental magnesium) for 16 weeks showed significant reductions in fasting glucose and glycosylated hemoglobin concentrations compared with participants receiving a placebo, and their serum magnesium levels became normal [49]. In contrast, neither a supplement of magnesium aspartate (providing 369 mg/day elemental magnesium) nor a placebo taken for 3 months had any effect on glycemic control in 50 patients with type 2 diabetes who were taking insulin [50].

The American Diabetes Association states that there is insufficient evidence to support the routine use of magnesium to improve glycemic control in people with diabetes [47]. It further notes that there is no clear scientific evidence that vitamin and mineral supplementation benefits people with diabetes who do not have underlying nutritional deficiencies.

Osteoporosis

Magnesium is involved in bone formation and influences the activities of osteoblasts and osteoclasts [51]. Magnesium also affects the concentrations of both parathyroid hormone and the active form of vitamin D, which are major regulators of bone homeostasis. Several population-based studies have found positive associations between magnesium intake and bone mineral density in both men and women [52]. Other research has found that women with osteoporosis have lower serum magnesium levels than women with osteopenia and those who do not have osteoporosis or osteopenia [53]. These and other findings indicate that magnesium deficiency might be a risk factor for osteoporosis [51].

Although limited in number, studies suggest that increasing magnesium intakes from food or supplements might increase bone mineral density in postmenopausal and elderly women [1]. For example, one short-term study found that 290 mg/day elemental magnesium (as magnesium citrate) for 30 days in 20 postmenopausal women with osteoporosis suppressed bone turnover compared with placebo, suggesting that bone loss decreased [54].

Diets that provide recommended levels of magnesium enhance bone health, but further research is needed to elucidate the role of magnesium in the prevention and management of osteoporosis.

Migraine headaches

Magnesium deficiency is related to factors that promote headaches, including neurotransmitter release and vasoconstriction [55]. People who experience migraine headaches have lower levels of serum and tissue magnesium than those who do not.

However, research on the use of magnesium supplements to prevent or reduce symptoms of migraine headaches is limited. Three of four small, short-term, placebo-controlled trials found modest reductions in the frequency of migraines in patients given up to 600 mg/day magnesium [55]. The authors of a review on migraine prophylaxis suggested that taking 300 mg magnesium twice a day, either alone or in combination with medication, can prevent migraines [56].

In their evidence-based guideline update, the American Academy of Neurology and the American Headache Society concluded that magnesium therapy is “probably effective” for migraine prevention [57]. Because the typical dose of magnesium used for migraine prevention exceeds the UL, this treatment should be used only under the direction and supervision of a healthcare provider.

Health Risks from Excessive Magnesium

Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine [31]. However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping [1]. Forms of magnesium most commonly reported to cause diarrhea include magnesium carbonate, chloride, gluconate, and oxide [14]. The diarrhea and laxative effects of magnesium salts are due to the osmotic activity of unabsorbed salts in the intestine and colon and the stimulation of gastric motility [58].

Very large doses of magnesium-containing laxatives and antacids (typically providing more than 5,000 mg/day magnesium) have been associated with magnesium toxicity [59], including fatal hypermagnesemia in a 28-month-old boy [60] and an elderly man [61]. Symptoms of magnesium toxicity, which usually develop after serum concentrations exceed 1.74–2.61 mmol/L, can include hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, extreme hypotension, irregular heartbeat, and cardiac arrest [31]. The risk of magnesium toxicity increases with impaired renal function or kidney failure because the ability to remove excess magnesium is reduced or lost [1,31].

The FNB has established ULs for magnesium that apply only to supplemental magnesium for healthy infants, children, and adults (see Table 3) [1].

Table 3: Tolerable Upper Intake Levels (ULs) for Supplemental Magnesium [1]

Age	Male	Female	Pregnant	Lactating
Birth to 12 months	None established	None established
1–3 years	65 mg	65 mg
4–8 years	110 mg	110 mg
9–18 years	350 mg	350 mg	350 mg	350 mg
19+ years	350 mg	350 mg	350 mg	350 mg

 

Interactions with Medications

Several types of medications have the potential to interact with magnesium supplements or affect magnesium status. A few examples are provided below. People taking these and other medications on a regular basis should discuss their magnesium intakes with their healthcare providers.

Bisphosphonates

Magnesium-rich supplements or medications can decrease the absorption of oral bisphosphonates, such as alendronate (Fosamax®), used to treat osteoporosis [62]. Use of magnesium-rich supplements or medications and oral bisphosphonates should be separated by at least 2 hours [58].

Antibiotics

Magnesium can form insoluble complexes with tetracyclines, such as demeclocycline (Declomycin®) and doxycycline (Vibramycin®), as well as quinolone antibiotics, such as ciprofloxacin (Cipro®) and levofloxacin (Levaquin®). These antibiotics should be taken at least 2 hours before or 4–6 hours after a magnesium-containing supplement [58,63].

Diuretics

Chronic treatment with loop diuretics, such as furosemide (Lasix®) and bumetanide (Bumex®), and thiazide diuretics, such as hydrochlorothiazide (Aquazide H®) and ethacrynic acid (Edecrin®), can increase the loss of magnesium in urine and lead to magnesium depletion [64]. In contrast, potassium-sparing diuretics, such as amiloride (Midamor®) and spironolactone (Aldactone®), reduce magnesium excretion [64].

Proton pump inhibitors

Prescription proton pump inhibitor (PPI) drugs, such as esomeprazole magnesium (Nexium®) and lansoprazole (Prevacid®), when taken for prolonged periods (typically more than a year) can cause hypomagnesemia [65]. In cases that FDA reviewed, magnesium supplements often raised the low serum magnesium levels caused by PPIs. However, in 25% of the cases, supplements did not raise magnesium levels and the patients had to discontinue the PPI. FDA advises healthcare professionals to consider measuring patients’ serum magnesium levels prior to initiating long-term PPI treatment and to check magnesium levels in these patients periodically [65].

Magnesium and Healthful Diets

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods. … Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.”

For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture’s MyPlate.

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

• Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.

  Whole grains and dark-green, leafy vegetables are good sources of magnesium. Low-fat milk and yogurt contain magnesium as well. Some ready-to-eat breakfast cereals are fortified with magnesium.

• Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.

  Dried beans and legumes (such as soybeans, baked beans, lentils, and peanuts) and nuts (such as almonds and cashews) provide magnesium.

• Limits saturated and trans fats, added sugars, and sodium.
• Stays within your daily calorie needs.

Magnesium chloratum Bundesanzeiger Nr. 86 vom 6.5.1994

Monographie BGA/BfArM (Kommission D)

ZDRAVLJE u 3 minute – Opasnost deficijencije magnezija

X X X X X

PRIČA O INZULINU I ČUDOTVORNOM MINERALU – MAGNEZIJU

Magnezij je nužan kako u proizvodnji tako i u djelovanju inzulina

Magnezij je osnovni gradijent života i prisutan je u kompletnoj životnoj fiziologiji. Bez inzulina Magnezij se ne može transportirati iz krvi u stanice gdje mu je, u stvari mjesto i gdje je najpotrebniji. Kad je dr Nadler stavio 16 pacijenata na dijetu osiromašenu Magnezijem, pokazalo se da je njihov inzulin postao nedjelotvoran i nije uspijevao da šećer iz krvi prebacuje u stanice gdje ih je trebao sagorjeti ili sačuvati kao „gorivo“. Drugim riječima, postajali su manje osjetljivi na inzulin, odnosno, „Inzulin rezistentni“ a, to je prvi korak na putu ka dijabetesu ili srčanim problemima.

Inzulin je „zajednički nazivnik“ dok je glavna uloga u životu povjerena Magneziju. Zadatak Inzulina je da sprema višak nutritivnih izvora, što je razvijano kroz evoluciju, kako bi se sačuvali energenti za period kad ih ne bude dovoljno. Nije uloga Inzulina samo regulacija šećera u stanicama već takođe i Magnezija, jedne od najvažnijih životnih tvari. Interesantno je ovdje napomenuti da bubrezi čiste iz organizma višak nuticionenata, odnosno, ono što tijelu nije trenutno potrebno, tj. ono što ne može u tom trenutku iskoristiti.

Kontrola šećera u krvi je samo jedna od mnogih funkcija Inzulina.

Inzulin igra glavnu ulogu u raspoređivanju i prihvatu Magnezija ali, ako stanice postanu rezistentne na Inzulin ili, ako organizam ne proizvodi dovoljno Inzulina, nastaje problem raspoređivanja Magnezija u stanice gdje inače pripada. Kad proizvodnja Inzulina postane problematična, Magnezij se povećano izlučuje kroz mokraću i to je osnova za bolest koja se naziva „Bolest gubitka Magnezija“.

Postoji jaka povezanost između djelovanja Inzulina i Magnezija

Magnezij je izuzetno važan za djelovanje Inzulina. Nedostatak Magnezija u stanicama pojačava već pomenutu Inzulinsku rezistenciju.

Niska koncentracija Magnezija u stanicama je direktno povezana sa Inzulinskom rezistencijom i gubitkom tolerancije na glukozu, odnosno, sa smanjenim izlučivanjem Inzulina. Magnezij neposredno povečava osjetljivost na Inzulin, istovremeno smanjujući Insulinsku rezistenciju. Magnezij i Inzulin su nužni jedan drugome jer, bez dovoljno Magnezija pankreas neće izlučivati dovoljno Inzulina ili izlučeni Inzulin neće biti dovoljno jak da kontrolira šećer u krvi.

Magnezij u našim stanicama pomaže da se mišići opuste ali, ako ne možemo apsorbirati Magnezij zbog otpornosti stanica, tada ga gubimo, što uzrokuje stezanje krvnih žila i pad energije, odnosno, povećanje krvnog tlaka. Ovdje možemo razumjeti neposrednu povezanost između dijabetesa i srčanih problema sa nedostatkom Magnezija i umanjenim djelovanjem Inzulina.

U studiji sa Tajvana, pokazano je da je rizik umiranja od dijabetesa bio obrnuto proporcionalan nivou Magnezija u vodi za piće.

Dr Jery L. Nadler

Inzulin regulira i nivo kolesterola. Postoji neposredna veza između nivoa kolesterola i nivoa Inzulina.

Diabetes mellitus je direktno povezan sa nedostatkom Magnezija koji, ujedno, doprinosi metaboličkim komplikacijama prouzročenim dijabetom uključujući probleme s mišičima i osteoporozu. Među-stanični nedostatak Magnezija neposredno je povezan sa smanjenom sposobnošću Inzulina da poveća među-stanično prisustvo Magnezija za vrijeme Inzulinske rezistencije ili nedostatka Inzulina.

Inzulinska rezistencija i nedostatak Magnezija stvaraju „začarani krug“ pogoršavanja inzulinske rezistencije i smanjenja inter-stanične prisutnosti (ionske) Magnezija što uzrokuje ograničenje Magnezija u vitalnim staničnim procesima. Magnezij je vitalni faktor uključen u enzime za metabolizam šećera, tako da sve što ograničava Magnezij, ograničava kompletan metabolizam. Velika epidemiološka ispitivanja sprovedena na odraslima, pokazuju da je dijeta (ishrana) siromašna Magnezijem, direktno povezana sa povećanim rizikom obolijevanja od Dijabeta tipa 2.

Pokazalo se da Inzulin može uzrokovati smanjenu distribuciju Magnezija u stanicama.

Veza između Dijabetesa melitusa i nedostatka Magnezija je vrlo dobro poznata. Sve veći broj svjedočenja ukazuje da Magnezij igra vodeću ulogu u smanjenju kardiovaskularnih problema i da je direktno uključen u patogenezu samog dijabetesa.

Dr. Jerry L. Nadler

Magnezij poboljšava i popravlja osjetljivost na Inzulin, što je osnovni problem u pre-dijabetskom metaboličkom sindromu i glavni pokretač dijabeta i srčanih problema. Među-stanični enzim pod nazivom Tyrosine Kinase bez Magnezija ne može omogućiti Inzulinu da regulira šećer u krvi. U različitim studijama, pokazalo se da dnevna oralna upotreba Magnezija podiže inzulinsku osjetljivost za 10 % i da smanjuje šećer u krvi za 37 %. Magnezij, takođe, pomaže u korekciji nenormalnih lipoproteina. Potpuno su razumljiva očekivanja da kombinirano unošenje Magnezij klorida preko kože (Trans-dermal, Magnezijevo ulje) i oralno, doprinose mnogo boljim rezultatima nego konvencionalno unošenje Magnezij oksida preko tableta.

Povećana Inzulinska osjetljivost postignuta unošenjem Magnezij klorida može značajno reducirati nivo Triglicerida. Što nadalje vodi ka reduciranju Lipoproteina niske gustine (VLDL i LDL) koji su vrlo značajni faktor kod srčanih problema. Unošenje Magnezij klorida takođe podiže nivo kvalitetnih Lipoproteina velike gustine (HDL).

Inzulin regulira i međustanični (na membrani) odnos iona Natrija i Magnezija. Upravo taj niski odnos Na/Mg razmijene može objasniti nisku staničnu apsorbciju Magnezija kad je u pitanju povišeno stanje Inzulina (hyperinsulinemic).

Magnezij je neophodan životni element bilo da su u pitanju životinje ili biljke. Klorofil je okupljen oko atoma Magnezija dok je kod životinja to ključna komponenta svake stanice, kostiju, tkiva i bilo kojeg fiziološkog procesa kojeg možete da se sjetite. Sam Život ljubomorno pakuje Magnezij u stanice, tretirajući „svaku kap“ kao dragocjenost.

Magnezij povećava inzulinsku osjetljivost istovremeno smanjujući inzulinsku otpornost. MAGNEZIJ I INZULIN SU JEDAN DRUGOM NUŽNI. Bez Magnezija naš pankreas neće lučiti dovoljno Inzulina ili taj Inzulin neće biti dovoljno efikasan da kontrolira šećer u krvi. Inzulin je hormon i kao većina hormona – on je protein. On se luči od grupe stanica pankreasa koje se nazivaju „stajališne stanice“. Inzulin je daleko važniji i ima mnogo više funkcija u organizmu nego je to bilo ko od nas svjestan.

Pored šećera, regulira još mnogo toga u našem organizmu: lipide / mišićnu masu / proteine / kalcij i magnezij / nivo natrija / staničnu diobu / rast hormona / funkciju jetre / polne hormone: estrogen, progesteron, testosteron / holesterol / masno tkivo.

Nedostatak Magnezija je direktno povezan s među-staničnim nivoom Kalcija, koji može dovesti do otpornosti na inzulin. Nizak sadržaj Magnezija u eritrocitima povećava membransku mikro-prolaznost što može dovesti do spriječavanja povezivanja Inzulina sa njegovim receptorima. Kod pokusa na štakorima, pokazalo se da je aktivnost Tyrosin kinaze uveliko smanjena u mišičnim receptorima u slučajevima kod manjka Magnezija. Ova istraživanja ukazuju na direktnu povezanost nedostatka Magnezija i djelovanja Inzulina.

Kad razina Magnezija opadne, pojača se lučenje Adrenalina i Inzulina. Njihovo pojačano lučenje pomaže održavanje konstantne razine Magnezija u među-staničnom prostoru mekih tkiva. Kako Plazma, tako i među-stanične koncentracije magnezija su tijesno regulirane Inzulinom. Pokusi u živo  i „u epruveti“ su pokazali da Inzulin direktno modulira prelazak Magnezija iz izvan-staničnog prostora u samu stanicu.

Dr Ron Rosedale je rekao da svaki „iskorak“ inzulina sa standarnog puta uzrokuje kardiovaskularne probleme – što je opet, direktno, povezano sa prisustvom Magnezija u organizmu.

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MAGNEZILUM HLORID I MAGNEZIJUM SULFAT

Adverse Effects

Excessive parenteral doses of magnesium salts lead to the development of hypermagnesaemia, important signs of which are respiratory depression and loss of deep tendon reflexes, both due to neuromuscular blockade. Other symptoms of hypermagnesaemia may include nausea, vomiting, flushing of the skin, thirst, hypotension due to peripheral vasodilatation, drowsiness, confusion, slurred speech, double vision, muscle weakness, bradycardia, coma, and cardiac arrest.

Hypermagnesaemia is uncommon after oral magnesium salts except in the presence of renal impairment. Ingestion of magnesium salts may cause gastrointestinal irritation and watery diarrhoea.

Effects on the gastrointestinal tract.

There are isolated reports of paralytic ileus in patients receiving magnesium salts.1,2 Delayed intestinal transit has also been reported in a neonate who received an intramuscular overdose of magnesium.3 See also Pregnancy, under Precautions, Go to Pregnancy..

1. Hill WC, et al. Maternal paralytic ileus as a complication of magnesium sulfate tocolysis. Am J Perinatol 1985; 2 47–8. PubMed
2. Golzarian J, et al. Hypermagnesemia-induced paralytic ileus. Dig Dis Sci 1994; 39 1138–42. PubMed
3. Narchi H. Neonatal hypermagnesemia more causes and more symptoms. Arch Pediatr Adolesc Med 2001; 155 1074. PubMed

Hypersensitivity.

Hypersensitivity reactions characterised by urticaria were described in 2 women after receiving magnesium sulfate intravenously.1

1. Thorp JM, et al. Hypersensitivity to magnesium sulfate. Am J Obstet Gynecol 1989; 161 889–90. PubMed

Treatment of Adverse Effects

The management of hypermagnesaemia is reviewed on Go to Hypermagnesaemia..

Hypermagnesaemia.

A patient with hypermagnesaemia of a degree that is normally fatal was successfully treated using assisted ventilation, calcium chloride administered intravenously, and forced diuresis with mannitol infusions.1 In another report, a 7-year-old boy given an Epsom salt (magnesium sulfate) enema for abdominal cramping, developed asystole and died, despite aggressive attempts at resuscitation. Such enemas should be avoided because of the risk of significant, unpredictable rectal absorption, leading to toxic hypermagnesaemia.2

1. Bohman VR, Cotton DB. Supralethal magnesemia with patient survival. Obstet Gynecol 1990; 76 984–6. PubMed
2. Tofil NM, et al. Fatal hypermagnesaemia caused by an Epsom salt enema a case illustration. South Med J 2005; 98 253–6. PubMed

Precautions

Parenteral magnesium salts should generally be avoided in patients with heart block or severe renal impairment. They should be used with caution in less severe degrees of renal impairment and in patients with myasthenia gravis. Patients should be monitored for clinical signs of excess magnesium (see Adverse Effects, Go to Adverse Effects), particularly when being treated for conditions not associated with hypomagnesaemia such as eclampsia. An intravenous preparation of a calcium salt should be available in case of toxicity. When used for hypomagnesaemia, serum-magnesium concentrations should be monitored.

Magnesium crosses the placenta. When used in pregnant women, fetal heart rate should be monitored and use within 2 hours of delivery should be avoided (see also Pregnancy, Go to Pregnancy.).

Oral magnesium salts should be used cautiously in patients with renal impairment. Taking with food may decrease the incidence of diarrhoea. Chronic diarrhoea from long-term use may result in electrolyte imbalance.

Breast feeding.

In breast milk samples from 10 pre-eclamptic women given magnesium sulfate, mean magnesium concentrations 24 hours after delivery were about 6.4 mg per 100 mL, and significantly higher than those in control subjects. However, by 48 and 72 hours after delivery, values were not significantly different. In both treated and control subjects, milk-magnesium concentrations were about twice those of maternal plasma concentrations. Although total doses of magnesium given to mothers may differ, the authors considered any increased magnesium load to a breast-fed infant to be quite small, about 1.5 mg of additional magnesium daily, and unlikely to significantly alter magnesium clearance from the neonate.1 Based on this, the American Academy of Pediatrics considers that use of magnesium sulfate is therefore usually compatible with breast feeding.2

1. Cruikshank DP, et al. Breast milk magnesium and calcium concentrations following magnesium sulfate treatment. Am J Obstet Gynecol 1982; 143 685–8. PubMed
2. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 776–89. PubMed Correction. ibid.; 1029. Also available at online (accessed 180504)

Hepatic disorders.

Severe hypermagnesaemia and hypercalcaemia developed in 2 patients with hepatic encephalopathy given magnesium sulfate enemas; both patients died, one during and one after asystole. It was recommended that patients with liver disease who might develop renal impairment, or in whom renal failure is established, should not be prescribed enemas containing magnesium for treatment of hepatic encephalopathy as serious magnesium toxicity can occur, which may contribute to death.1

1. Collinson PO, Burroughs AK. Severe hypermagnesaemia due to magnesium sulphate enemas in patients with hepatic coma. BMJ 1986; 293 1013–14. PubMed Correction. ibid.; 1222.

Pregnancy.

The meconium-plug syndrome (abdominal distention and failure to pass meconium) has been described in 2 neonates who were hypermagnesaemic after their mothers had received magnesium sulfate for eclampsia.1 It was believed that the hypermagnesaemia may have depressed the function of intestinal smooth muscle. See also Effects on the Gastrointestinal Tract, Go to Effects on the gastrointestinal tract.. In 36 hypermagnesaemic infants born to pre-eclamptic mothers treated with magnesium sulfate, significant neurobehavioural impairment persisted for over 24 hours after birth. Impairment was manifest by prolonged weakness in activities such as head lag, ventral suspension, suck reflex, and cry response; improvement corresponded to the decrease in plasma-magnesium concentrations.2

In studies in women with3 and without4 pre-eclampsia there were decreases in short-term fetal heart rate variability when women were given intravenous magnesium sulfate; however, although variability is considered a sign of fetal well-being the decrease was considered clinically insignificant.

1. Sokal MM, et al. Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med 1972; 286 823–5. PubMed
2. Rasch DK, et al. Neurobehavioral effects of neonatal hypermagnesemia. J Pediatr 1982; 100 272–6. PubMed
3. Atkinson MW, et al. The relation between magnesium sulfate therapy and fetal heart rate variability. Obstet Gynecol 1994; 83 967–70. PubMed
4. Hallak M, et al. The effect of magnesium sulfate on fetal heart rate parameters a randomized, placebo-controlled trial. Am J Obstet Gynecol 1999; 181 1122–7. PubMed

Interactions

Parenteral magnesium sulfate potentiates the effects of competitive and depolarising neuromuscular blockers (Go to Magnesium salts.). The neuromuscular blocking effects of parenteral magnesium and aminoglycoside antibacterials may be additive. Similarly, parenteral magnesium sulfate and nifedipine have been reported to have additive effects (Go to Magnesium salts.).

Oral magnesium salts decrease the absorption of tetracyclines and bisphosphonates, and doses should be separated by a number of hours.

Pharmacokinetics

About one-third of magnesium is absorbed from the small intestine after oral doses and even soluble magnesium salts are generally very slowly absorbed. The fraction of magnesium absorbed increases if magnesium intake decreases. In plasma, about 25 to 30% of magnesium is protein bound. Parenteral magnesium salts are excreted mainly in the urine, and oral doses are eliminated in the urine (absorbed fraction) and the faeces (unabsorbed fraction). Small amounts are distributed into breast milk. Magnesium crosses the placenta.

Human Requirements

Magnesium is the second most abundant cation in intracellular fluid and is an essential body electrolyte which is a cofactor in numerous enzyme systems.

The body is very efficient at maintaining magnesium concentrations by regulating absorption and renal excretion, and symptoms of deficiency are rare. It is therefore difficult to establish a daily requirement.

Foods rich in magnesium include nuts, unmilled grains, and green vegetables.

UK and US recommended dietary intake.

In the United Kingdom dietary reference values (DRV—see Go to Human requirements.)1 and in the United States recommended daily allowances (RDA)2 have been published for magnesium. In the UK the estimated average requirement (EAR) is 200 mg (or 8.2 mmol) daily for adult females and 250 mg (or 10.3 mmol) daily for adult males; the reference nutrient intake (RNI) is 270 mg (or 10.9 mmol) daily for adult females and 300 mg (or 12.3 mmol) daily for adult males; no increment is recommended during pregnancy but an increment of 50 mg (or 2.1 mmol) daily in the RNI is advised during lactation. In the USA under the new dietary reference intakes an EAR of 330 to 350 mg daily has been set in adult males and 255 to 265 mg daily in adult females; the corresponding RDAs are 400 to 420 mg and 310 to 320 mg daily.2 An increase in RDA to 350 to 360 mg is recommended during pregnancy but the standard RDA is considered adequate during lactation. A tolerable upper intake level of 350 mg daily has been set for adults.2

1. DoH. Dietary reference values for food energy and nutrients for the United Kingdom report of the panel on dietary reference values of the committee on medical aspects of food policy. Report on health and social subjects 41. London HMSO, 1991. PubMed
2. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board. Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC National Academy Press, 1999. Also available at online (accessed 180406)

Uses and Administration

Some magnesium salts are given as a source of magnesium ions in the treatment of magnesium deficiency and hypomagnesaemia (Go to Hypomagnesaemia.). Doses may be expressed in terms of mmol or mEq of magnesium, mass (mg) of magnesium, or mass of magnesium salt. In acute or severe hypomagnesaemia, magnesium may be given parenterally, usually as the chloride or sulfate. One suggested regimen is 20 mmol of magnesium in 1 litre of infusion solution (glucose 5% or sodium chloride 0.9%) given intravenously over 3 hours. Alternatively, 35 to 50 mmol of magnesium in 1 litre of infusion solution may be given over a period of 12 to 24 hours. Up to a total of 160 mmol may be required over 5 days. In those receiving parenteral nutrition, doses of about 12 mmol magnesium daily may be given to prevent recurrence of the deficit. Magnesium sulfate can also be given intramuscularly for severe magnesium deficiency. A recommended dose is 1 mmolkg of magnesium, given over a period of 4 hours; this route is stated to be painful. Careful monitoring of plasma-magnesium and other electrolyte concentrations is essential. Doses should be reduced in renal impairment. Other salts which are, or have been, used parenterally include magnesium ascorbate, magnesium aspartate hydrochloride, and magnesium pidolate.

In simple deficiency states magnesium salts may be given by mouth in doses adjusted according to individual requirements. For preventing recurrence of hypomagnesaemia, doses of 24 mmol daily in divided doses have been recommended. Salts that are, or have been, used orally include magnesium aspartate, magnesium chloride, magnesium citrate, magnesium gluceptate, magnesium gluconate, magnesium glycerophosphate, magnesium lactate, magnesium levulinate, magnesium orotate, and magnesium pidolate.

Magnesium salts such as the carbonate, hydroxide, oxide, and trisilicate are widely used for their antacid properties (Go to Antacids). Magnesium salts also act as osmotic laxatives (see Constipation, Go to Constipation); the salts generally used for this purpose are magnesium sulfate (an oral dose of 5 to 10 g in 250 mL of water being given for rapid bowel evacuation) and magnesium hydroxide (Go to Magnesium Hydroxide).

Parenteral magnesium sulfate has some specific uses. It is used for the emergency treatment of some arrhythmias such as torsade de pointes (see Go to Arrhythmias.) and those associated with hypokalaemia (Go to Hypokalaemia.). The usual dose is 2 g of magnesium sulfate (8 mmol of magnesium) given intravenously over 10 to 15 minutes and repeated once if necessary.

Parenteral magnesium sulfate is also used for the prevention of recurrent seizures in pregnant women with eclampsia (see Go to Eclampsia and pre-eclampsia.). Debate continues as to which dosage regimen is most appropriate. Typically an intravenous loading dose of 4 g of magnesium sulfate (16 mmol of magnesium) is given over 10 to 15 minutes. This is then followed by either an infusion of 1 g (4 mmol magnesium) per hour (for at least 24 hours after the last seizure) or by deep intramuscular injection of 5 g (20 mmol magnesium) into each buttock then 5 g intramuscularly every 4 hours (for at least 24 hours after the last seizure). Should seizures recur under either regimen, then an additional intravenous dose of 2 to 4 g can be given. It is essential to monitor for signs of hypermagnesaemia, and to stop magnesium dosage should this occur. Doses should be reduced in renal impairment.

The use of magnesium sulfate in acute myocardial infarction and premature labour is discussed below (see Go to Myocardial infarction. and Go to Premature labour., respectively).

Dried magnesium sulfate has been used in the form of Magnesium Sulphate Paste (BP 2005) as an application to inflammatory skin conditions such as boils and carbuncles, but prolonged or repeated use may damage the surrounding skin.

General references.

1. McLean RM. Magnesium and its therapeutic uses a review. Am J Med 1994; 96 63–76. PubMed
2. Fawcett WJ, et al. Magnesium physiology and pharmacology. Br J Anaesth 1999; 83 302–20. PubMed
3. Fox C, et al. Magnesium its proven and potential clinical significance. South Med J 2001; 94 1195–1201. PubMed
4. Gums JG. Magnesium in cardiovascular and other disorders. Am J Health-Syst Pharm 2004; 61 1569–76. PubMed

Anaesthesia.

Magnesium sulfate has been used to prevent the undesirable haemodynamic response sometimes associated with intubation (Go to Anaesthesia). It has also been tried in the treatment of postanaesthetic shivering (Go to Shivering and its treatment.).

Arrhythmias.

Parenteral magnesium is used for the treatment of some arrhythmias such as torsade de pointes (Go to Cardiac arrhythmias). However, for the suggestion that it did not have an antiarrhythmic effect in patients with myocardial infarction see Myocardial Infarction, Go to Myocardial infarction..

Further references.

1. Frick M, et al. The effect of oral magnesium, alone or as an adjuvant to sotalol, after cardioversion in patients with persistent atrial fibrillation. Eur Heart J 2000; 21 1177–85. PubMed
2. Stuhlinger HG, et al. Der Stellenwert von Magnesium bei Herzrhythmusstorungen. Wien Med Wochenschr 2000; 150 330–4. PubMed
3. Piotrowski AA, Kalus JS. Magnesium for the treatment and prevention of atrial tachyarrhythmias. Pharmacotherapy 2004; 24 879–95. PubMed
4. Shiga T, et al. Magnesium prophylaxis for arrhythmias after cardiac surgery a meta-analysis of randomized controlled trials. Am J Med 2004; 117 325–33. PubMed
5. Alghamdi AA, et al. Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery a systematic review and meta-analysis. J Card Surg 2005; 20 293–9. PubMed
6. Miller S, et al. Effects of magnesium on atrial fibrillation after cardiac surgery a meta-analysis. Heart 2005; 91 618–23. PubMed

Eclampsia and pre-eclampsia.

Magnesium sulfate has become the preferred treatment for seizures associated with eclampsia (Go to Eclampsia and pre-eclampsia.). Studies and systematic reviews have shown it to be more effective than phenytoin,1,2 diazepam,1,3 or lytic cocktail,4 as well as causing fewer adverse effects. Its advantages included a rapid effect and lack of sedation in the mother or the infant.5 It was also considered to have a wide safety margin with the added security of calcium gluconate being an easily available antidote should overdose occur. Subsequent meta-analysis6 and systematic review2-4 reinforced this favourable view.

Magnesium sulfate may also be used to prevent eclampsia in pre-eclamptic patients; trials have shown it to be more effective than phenytoin,7 or nimodipine.8 A randomised placebo-controlled trial9 involving over 10 000 women in 33 countries found that treatment with magnesium sulfate approximately halved the risk of developing eclampsia; the number of maternal deaths was also less in the treatment group although the differences in risk between this group and the placebo group were not significant.

Despite some concerns about the effects of early use of magnesium sulfate on the fetus (see Premature Labour, Go to Premature labour.), many,10,11 including WHO, consider magnesium sulfate the drug of choice for both treatment and prevention of eclampsia.

1. The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia evidence from the Collaborative Eclampsia Trial. Lancet 1995; 345 1455–63. PubMed Correction. ibid.; 346 258.
2. Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2003 (accessed 210605). PubMed
3. Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2003 (accessed 210605). PubMed
4. Duley L, Gulmezoglu AM. Magnesium sulphate versus lytic cocktail for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2000 (accessed 210605). PubMed
5. Saunders N, Hammersley B. Magnesium for eclampsia. Lancet 1995; 346 788–9. PubMed
6. Chien PFW, et al. Magnesium sulphate in the treatment of eclampsia and pre-eclampsia an overview of the evidence from randomised trials. Br J Obstet Gynaecol 1996; 103 1085–91. PubMed
7. Lucas MJ, et al. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995; 333 201–5. PubMed
8. Belfort MA, et al. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003; 348 304–11. PubMed
9. The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate The Magpie Trial a randomised placebo-controlled trial. Lancet 2002; 359 1877–90. PubMed
10. Roberts JM, et al. Preventing and treating eclamptic seizures. BMJ 2002; 325 609–10. PubMed
11. WHO. Managing complications in pregnancy and childbirth a guide for midwives and doctors headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure. Available at online (accessed 180504)

Hypokalaemia.

Potassium and magnesium homoeostasis are linked, and hypokalaemia with increased urine potassium excretion may occur in patients with hypomagnesaemia. In this situation, correction of potassium deficit usually requires magnesium to be given as well. Magnesium sulfate at doses greater than those required to correct hypomagnesaemia has been associated with greater improvements in potassium balance than doses just sufficient to correct hypomagnesaemia.1

1. Hamill-Ruth RJ, McGory R. Magnesium repletion and its effect on potassium homeostasis in critically ill adults results of a double-blind, randomized, controlled trial. Crit Care Med 1996; 24 38–45. PubMed

Migraine.

Low magnesium concentrations are thought to be important in the pathogenesis of migraine (Go to Migraine), but the precise role of magnesium supplementation in the disorder remains to be determined.1 In a double-blind study,2 24 mmol magnesium daily (in the form of magnesium citrate) reduced the incidence of migraine headache by 42% compared with a reduction of 16% with placebo. However, in another similar study,3 20 mmol magnesium daily (in the form of magnesium aspartate hydrochloride) was no more effective than placebo in producing a 50% reduction in migraine frequency or intensity. Intravenous magnesium sulfate has shown benefit in the treatment of migraine attacks,4 especially in those with aura,5,6 or in patients with low serum-magnesium levels.7

1. Mauskop A, Altura BM. Role of magnesium in the pathogenesis and treatment of migraines. Clin Neurosci 1998; 5 24–7. PubMed
2. Peikert A, et al. Prophylaxis of migraine with oral magnesium results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16 257–63. PubMed
3. Pfaffenrath V, et al. Magnesium in the prophylaxis of migraine a double-blind placebo-controlled study. Cephalalgia 1996; 16 436–40. PubMed
4. Demirkaya Ş, et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache 2001; 41 171–7. PubMed
5. Bigal ME, et al. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura a randomized, double-blind, placebo-controlled study. Cephalalgia 2002; 22 345–53. PubMed
6. Bigal ME, et al. Eficácia de três drogas sobre a aura migranosa um estudo randomizado placebo controlado. Arq Neuropsiquiatr 2002; 60 406–9. PubMed
7. Mauskop A, et al. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels a pilot study. Clin Sci 1995; 89 633–6. PubMed

Myocardial infarction.

Magnesium has an important physiological role in maintaining the ion balance in muscle including the myocardium. Magnesium might have an antiarrhythmic effect (see also Arrhythmias, Go to Arrhythmias.) and protect the myocardium against reperfusion injury including myocardial stunning (delayed recovery of myocardial contractility function). Intravenous magnesium salts have been used for cardiac arrhythmias and in an overview of studies in patients with suspected myocardial infarction their use, generally within 12 hours of the onset of chest pain, reduced mortality.1 The beneficial effect on mortality appeared to be confirmed by the LIMIT-2 study2 in which 8 mmol of magnesium was given by intravenous injection before thrombolysis and followed by a maintenance infusion of 65 mmol over the next 24 hours. Benefit was confirmed at follow-up an average of 2.7 years later;3 however, there was no evidence of an antiarrhythmic effect. These beneficial effects were not borne out by the larger ISIS-4 study,4 although there were slight differences in the magnesium regimen and its timing which might have played a part in these contradictory results. In an attempt to resolve the controversy, the MAGIC trial5 was designed to test the hypothesis that early use of magnesium in a similar dose to that used in the LIMIT-2 study would reduce short-term mortality in patients with ST elevation myocardial infarction. No benefit or harm of magnesium was observed, and at present the routine use of magnesium in myocardial infarction (Go to Myocardial infarction) cannot be recommended.

Patients with acute myocardial infarction may have magnesium deficiency and long-term treatment with oral magnesium has been tried, but in one study was associated with an increased risk of adverse cardiac events and could not be recommended for secondary prevention.6

1. Teo KK, et al. Effects of intravenous magnesium in suspected acute myocardial infarction overview of randomised trials. BMJ 1991; 303 1499–1503. PubMed
2. Woods KL, et al. Intravenous magnesium sulphate in suspected acute myocardial infarction results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992; 339 1553–8. PubMed
3. Woods KL, Fletcher S. Long-term outcome after intravenous magnesium sulphate in suspected acute myocardial infarction the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1994; 343 816–19. PubMed
4. Fourth International Study of Infarct Survival Collaborative Group. ISIS–4 a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction. Lancet 1995; 345 669–85. PubMed
5. The Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) trial a randomised controlled trial. Lancet 2002; 360 1189–96. PubMed
6. Galløe AM, et al. Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction. BMJ 1993; 307 585–7. PubMed

Porphyria.

Magnesium sulfate is one of the drugs that has been used for seizure prophylaxis in patients with porphyria (Go to Porphyria.) who continue to experience convulsions while in remission.

Premature labour.

Pulmonary hypertension of the newborn.

Preliminary studies have suggested that intravenous magnesium sulfate may be effective in treating persistent pulmonary hypertension of the newborn, as mentioned on Go to Pulmonary hypertension.

Respiratory disorders.

Magnesium sulfate, given intravenously over 20 minutes in doses of 1.2 g to patients with acute exacerbations of chronic obstructive pulmonary disease (Go to Chronic obstructive pulmonary disease) who had received inhaled salbutamol, appeared to have moderate efficacy.1

Infusion of magnesium has been reported to be of benefit in some patients with acute asthma (Go to Asthma), but results have been conflicting;2-5 meta-analyses of these and other studies concluded that its routine use was not justified, but that it may benefit some patients with severe exacerbations.6,7 A meta-analysis of 5 trials in children concluded that intravenous magnesium sulfate is likely to be an effective adjunct to standard therapy in the symptomatic treatment of moderate to severe acute childhood asthma.8 Inhalation of magnesium has also been investigated, either alone or with salbutamol; another meta-analysis considered that it improved pulmonary function, particularly in combination with a beta2 agonist, with the best results seen in more severe cases.9

1. Skorodin MS, et al. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 1995; 155 496–500. PubMed
2. Skobeloff EM, et al. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA 1989; 262 1210–13. PubMed
3. Green SM, Rothrack SG. Intravenous magnesium for acute asthma failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med 1992; 21 260–5. PubMed
4. Ciarallo L, et al. Intravenous magnesium therapy for moderate to severe pediatric asthma results of a randomized, placebo-controlled trial. J Pediatr 1996; 129 809–14. PubMed
5. Silverman RA, et al. IV magnesium sulfate in the treatment of acute severe asthma a multicenter randomized controlled trial. Chest 2002; 122 489–97. PubMed
6. Rowe BH, et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Available in The Cochrane Database of Systematic Reviews; Issue 1. Chichester John Wiley; 2000 (accessed 210605). PubMed
7. Alter HJ, et al. Intravenous magnesium as an adjuvant in acute bronchospasm a meta-analysis. Ann Emerg Med 2000; 36 191–7. PubMed
8. Cheuk DKL, et al. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child 2005; 90 74–7. PubMed
9. Blitz M, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2005 (accessed 051005). PubMed

Stroke.

Intravenous magnesium sulfate has been investigated for a neuroprotective effect in stroke (Go to Stroke), but results have been largely disappointing.1

1. Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium efficacy in Stroke trial) randomised controlled trial. Lancet 2004; 363 439–45. PubMed

 Tetanus.

Magnesium sulfate has been found to minimise autonomic disturbance in ventilated patients and control spasms in non-ventilated patients when used in the treatment of tetanus (Go to Tetanus).

References.

1. Attygalle D, Rodrigo N. Magnesium as first line therapy in the management of tetanus a prospective study of 40 patients. Anaesthesia 2002; 57 811–17. PubMed
2. William S. Use of magnesium to treat tetanus. Br J Anaesth 2002; 88 152–3. PubMed

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