Magnesium: The recent research and developments

A Comprehensive Review of Electrolyte Imbalances and Their Applied Aspects in Dermatology

Electrolytes play a pivotal role in the maintenance of neutrality in the minerals of the cells - also, the generation and conduction of action potentials in neurons and muscles. Key electrolytes include sodium, potassium, chloride, magnesium, calcium, and phosphate. Electrolyte imbalances can result in elevated or diminished levels. Abnormal electrolyte levels, whether raised or decreased, interfere with normal physiological activities and may result in life-threatening consequences. Electrolyte imbalances are common in critical care units, although they are less frequent in dermatological conditions. Dermatologists should, however, be knowledgeable about the skin disorders and medications that are related to or may increase the risk of electrolyte imbalance to ensure that appropriate treatments are implemented immediately to avoid negative results. The objective of this review is to narrate the dermatological features of disorders involving abnormalities of sodium, potassium, calcium, phosphorus, and magnesium.

The Novel Imipramine-Magnesium Complex Exerts Antidepressant-like Activity in Mice Subjected to the Forced Swim Test and the Tail Suspension Test

The objective of this study was to assess the antidepressant efficacy of a novel imipramine-magnesium (IMI-Mg) complex in comparison to the administration of imipramine and magnesium individually. The study utilized adult male albino Swiss mice. Behavioral assessments were conducted using the forced swim test (FST) and the tail suspension test (TST). A locomotor activity test was conducted to exclude false positive results in the FST and TST. Moreover, the study assessed oxidative stress levels in the mice subjected to acute environmental stress by measuring glutathione peroxidase, glutathione reductase, total oxidant status, and total antioxidant status. The administration of the IMI-Mg complex at doses of 5, 10, and 20 mg/kg resulted in a reduction in immobility time in both behavioral tests, thereby indicating the antidepressant-like potential of the tested complex, which was similar to the one observed after the administration of these two compounds as separate drug forms. The efficacy of the novel IMI-Mg complex represents a significant advancement and provides a foundation for future research. This innovative agent has the potential to enhance the safety profile of the therapy, streamline the treatment protocol, improve patient satisfaction, and promote adherence to the therapeutic regimen.

Association of magnesium deficiency scores with risk of rheumatoid arthritis and osteoarthritis in adults: a cross-sectional population-based study

BACKGROUND

The magnesium depletion score (MDS) is a scoring system developed to predict magnesium deficiency based on pathophysiological factors that affect renal reabsorption. The relationship between systemic magnesium status and arthritis is unclear. The purpose of this study was to determine the association between the MDS and rheumatoid arthritis (RA) as well as osteoarthritis (OA).

METHODS

This study was conducted through a cross-sectional survey of 20,513 adults aged ≥ 20 years who participated in NHANES from 2007 to 2018. The four dimensions of the MDS included diuretics, proton pump inhibitors, glomerular filtration rate, and excessive alcohol consumption. Univariate and multivariable-weighted logistic regression were used to assess the associations between MDS and RA/OA, and a test for trend was performed to analyze the presence of a dose-response relationship. Subgroup analyses and interaction tests were performed according to confounders.

RESULTS

After adjustment for all covariates, we found a graded dose-response relationship between MDS and RA or OA. When MDS was considered as a continuous variable, each onefold increase in MDS was associated with a 1.21-fold increase in the odds of having RA (OR = 1.21, 1.10, 1.33) and a 1.12-fold increase in the odds of having OA (OR = 1.12, 1.04, 1.21). There was an interaction of sex in the effect of MDS on RA (Pinteraction = 0.004) and age in the effect of MDS on OA (Pinteraction = 0.006). In addition, these associations were further confirmed in sensitivity and subgroup analyses.

CONCLUSIONS

Our study identified significant dose-response associations between MDS and both RA and OA. More biological mechanisms are needed in the future to validate and clarify the results of this study.

Prevalence, clinical characteristics, and health outcomes of dysmagnesemia measured by ionized and total body concentrations among medically hospitalized patients

Ionized Mg (iMg) may offer a more reliable indicator of Mg status during acute illness than total Mg (tMg) concentrations. This study aimed to determine the prevalence of dysmagnesemia and their relationship using iMg and tMg. The clinical and biochemical characteristics as well as health outcomes and their association with iMg and tMg were also assessed. A prospective study including all eligible adult patients (≥18 years) who were hospitalized in the General Internal Medicine unit at Sultan Qaboos University Hospital (SQUH) for 3.5 months in 2023. The iMg and tMg concentrations were collected on all at the admission. In total 500 patients were included (females 49.2%) with a median age of 64.5 years (IQR: 48-77). The prevalence of hypomagnesemia and hypermagnesemia by iMg concentrations was 3.4% and 26.6%, respectively, while by tMg concentrations 13.2% and 11.0%, respectively. The agreement between both measurements was strong (r=0.665, p<0.01). An increased tMg concentration was independently associated with high dependency units' admission (adjusted odds ratio (aOR): 4.34, 95%CI: 1.24-15.06, p=0.02) and cardiac arrest (aOR: 14.64, 95%CI: 3.04-70.57, p<0.01), and 6-month all-cause mortality (aOR: 11.44, 95%CI: 2.46-53.17, p<0.01). During follow-up hypermagnesemia using tMg had a higher mortality compared to other groups (hazard ratio (HR): 1.82, 95%CI: 1.11-3.01, p=0.02) while no significant findings were demonstrated using iMg concentrations. iMg and tMg concentrations had a strong correlation that might be supporting the potential use of point-of-care devices. Multivariant regression analysis showed that hypermagnesemia by tMg was associated with adverse outcomes. However, the generalizability of the study findings should be taken with caution and the difference in the associations with outcomes highlight the importance of further research to examine the complex associations and impacts of dysmagnesemia in various clinical settings.

Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study

BACKGROUND

Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes.

OBJECTIVES

Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia.

DESIGN

Retrospective cohort.

SETTING

Medical ward at tertiary hospital setting.

PATIENTS AND METHODS

The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge).

SAMPLE SIZE AND BASIS

The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin.

MAIN OUTCOME MEASURES

The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality.

RESULTS

In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]).

CONCLUSION

Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission.

LIMITATIONS

Single-centre design and retrospective nature.

Magnesium Ion: A New Switch in Tumor Treatment

The magnesium ion is an essential cation in the human body and participates in numerous physiological activities. A deficiency in magnesium ions is closely associated with tumor development, and supplementation with magnesium ions has been shown to partially inhibit tumor growth. However, the specific mechanisms by which magnesium ions suppress tumor proliferation remain unclear. Currently, studies have revealed that mitochondria may serve as a crucial intermediate link in the regulation of tumors by magnesium ions. Mitochondria might intervene in the proliferation and invasion of tumor cells by modulating energy metabolism and oxidative stress levels. Regrettably, there has been no comprehensive review of the role of magnesium in cancer therapy to date. Therefore, this article provides a comprehensive scrutiny of the relationship between magnesium ions and tumors, aiming to offer insights for clinical tumor treatment strategies involving magnesium ion intervention.

Case report: Near-fatal hypermagnesemia resulting from the use of Epsom salts in a patient with normal renal function

Hypermagnesemia commonly occurs in patients with renal dysfunction. Diagnosing hypermagnesemia represents a challenge due to its rarity and the absence of routine monitoring of magnesium levels. Furthermore, the lack of awareness among clinicians regarding this uncommon condition frequently leads to delayed diagnoses. Few patients survive with a serum magnesium level exceeding 7 mmol/L. This article presents a case study of near-fatal hypermagnesemia resulting from the oral administration of Epsom salts in a patient with normal renal function. A 60-year-old female presented to the gastroenterology department on Oct. 6, 2023, with a 3-day history of black stools. She underwent subtotal gastrectomy in 2005 and has a stable history of nephrotic syndrome. To investigate the cause of her bleeding, electronic gastroscopy and colonoscopy were scheduled for Oct. 11, 2023. She experienced a sudden loss of consciousness 30 min after the ingestion of Epsom salts. The attending physician suspected a severe magnesium poisoning. She was promptly administered calcium gluconate, underwent tracheal intubation with ambu bag ventilation, and received early continuous renal replacement therapy (CRRT). Swift diagnosis and CRRT contributed to a reduction in her serum magnesium levels from an initial 8.71 mmol/L to 1.35 mmol/L, leading to a remarkable improvement in the toxic symptoms associated with hypermagnesemia. Subsequently, she was managed in the gastroenterology department, with gastroscopy revealing bleeding from the gastrointestinal anastomotic ulcer. Following conservative treatments including acid suppression, stomach protection, and hemostasis, her symptoms improved, and she was successfully discharged. This study aims to alert clinicians to the possibility of hypermagnesemia in individuals with normal renal function. Physicians should exercise caution when prescribing Epsom salts to patients with underlying gastrointestinal conditions. If necessary, alternative drug therapies may be considered to mitigate the risk of hypermagnesemia. Timely intervention is pivotal in averting life-threatening complications linked to hypermagnesemia.

Zigzag boron nitride nanotube functionalization as a sensor for the recognition of group IIA (Mg2+, Ca2+) metal ions, quasi-metal (Si2+, Ge2+) ions, and transition metal (Cu2+, Zn2+) ions: a computational study

CONTEXT

Boron nitride nanotubes (BNNTs) provide an exceptional and sophisticated platform for detecting metal ions with high surface area and remarkable chemical stability. Metal cations tend to bind to the surface of BNNTs, which leads to significant changes in the electrical properties of nanotubes. BNNT-based metal ion sensors have shown promising results in various applications, including water quality monitoring, biomedical research, industrial quality control, and environmental monitoring. In the present study, we have explored the electronic sensitivity of the BNNT to metal ions (Si2+, Ge2+, Cu2+, Zn2+, Mg2+, and Ca2+). The interaction between the ions with the pristine BNNT is performed in the solution phase. The results show that ion adsorption on the nanotube surface is exothermic and favorable. The density of states calculation is presented to investigate the electronic properties of the nanotube during the adsorption process. The results display that an increase in the electrical conductivity of the complexes accompanies the reduction in the energy gap. Based on the obtained data, the Si2+ and Ge2+ cations adsorbed on the BNNT with satisfactory Eg changes (%ΔE) can be promising candidates for better sensing ability.

METHOD

All calculations are conducted within the density functional theory (DFT) using the ωB97XD functional and 6-31G(d,p) basis set. The present approach incorporates the utilization of empirical atom-atom dispersion in conjunction with long-range correction. The calculations are performed using the quantum chemistry package GAMESS, and the obtained results are visualized by employing the GaussView 6.0.16 program.

Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study

Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.

Incidence of Dysmagnesemia among Medically Hospitalized Patients and Associated Clinical Characteristics: A Prospective Cohort Study

Background

Magnesium (Mg) disorders are common among hospitalized patients and are linked to poor health outcomes. We aimed to determine the incidence of dysmagnesemia among medically hospitalized patients and to identify factors that are associated with dysmagnesemia.

Methods

A prospective cohort study was conducted at Sultan Qaboos University Hospital (SQUH) from April 1st, 2022, to October 31st, 2022, and involved hospitalized adult patients (≥18 years) under the care of the general internal medicine unit. The patients' serum total magnesium (Mg) concentrations were categorized as hypomagnesemia (≤0.69 mmol/L), hypermagnesemia (≥1.01 mmol/L), or dysmagnesemia, which encompassed either hypomagnesemia or hypermagnesemia.

Results

Of the 304 patients evaluated, dysmagnesemia was observed in 22.0%, which comprised of 17.4% with hypomagnesemia and 4.6% with hypermagnesemia. Statistically significant associations were identified between hypermagnesemia and chronic kidney disease (CKD) (p = 0.05) and elevated creatinine levels (p < 0.01) and lower estimated glomerular filtration rate (eGFR) (p < 0.01). Hypomagnesemia was linked to lower ionized calcium (p = 0.03) and admission due to infectious diseases (p = 0.02). However, ordered regression analysis did not find any significant associations with the different magnesium groups.

Conclusion

Dysmagnesemia was prevalent among hospitalized patients and was associated with different factors; however, ordered regression analysis did not find any association with the different magnesium group, probably due to the limited number of included individuals.

The Stability of Analytes of Ionized Magnesium Concentration and Its Reference Range in Healthy Volunteers

This study aimed to determine the stability of refrigerated analytes of iMg concentration at different time intervals and to establish iMg reference range in a cohort of healthy Omani volunteers (≥18 years). The concentrations of iMg were measured using the direct ion-selective electrode technique. Pearson's and Lin's concordance correlation coefficients along with the Bland-Altman plot were used to assess the levels of agreement between iMg concentrations of fresh and refrigerated blood samples at different time intervals. The study included 167 volunteers (51% females) with a median age of 21 (range: 20-25) years. The median, 2.5th, and 97.5th percentiles for fresh iMg reference ranges were 0.55, 0.47, and 0.68 mmol/L, respectively. The overall agreement between the fresh and refrigerated iMg concentrations was poor (rho-c = 0.51; p < 0.001). However, according to Altman's definition, iMg concentrations of the refrigerated samples for a period of ≤1 h had an excellent correlation with the fresh iMg concentrations (Lin's rho-c = 0.80), with a small average bias difference of 0.009 (95%CI; -0.025-0.043). A cut-off refrigeration period within ≤1 h at 2-8 °C can be considered an alternate time frame for the gold standard measurement (fresh or within 0.5 h).

Hypermagnesemia in Clinical Practice

Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is a prevalent electrolyte disturbance that can lead to several neuromuscular, cardiac, or nervous system disorders. Hypermagnesemia has been associated with adverse clinical outcomes, particularly in hospitalized patients. Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma. Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases. Furthermore, healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range.

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Calcium (Ca), potassium (K), sodium (Na), and magnesium (Mg) are the elements responsible for the fundamental metabolic and biochemical processes in the cells of the body. The demand for these elements increases significantly during pregnancy, where an adequate supply protects women from the hypertension common in pre-eclampsia and preterm labor. This study aimed to evaluate the association between macro-elements (Ca, Mg, Na, and K) in the placenta, fetal membrane, and umbilical cord and the morphometric parameters of newborns from multiple pregnancies. The study involved 57 pregnant European women with healthy uncomplicated twin pregnancies (n = 52) and triple pregnancies (n = 5); 40 pairs of dichorionic diamniotic twins, 11 pairs of monochorionic diamniotic twins, 1 pair of monochorionic monoamniotic twins, 3 trichorionic triamniotic triplets, and 2 dichorionic triamniotic triplets. Placentas (n = 107), umbilical cords (n = 114), and fetal membranes (n = 112) were collected immediately following delivery, and then weighed and measured. The levels of Ca, K, Na, and Mg were determined using inductively coupled plasma atomic emission spectroscopy (ICP-OES) in a Thermo Scientific ICAP 7400 Duo (Waltham, MA, USA). The respective mean concentrations of Ca, K, Na, and Mg (mg/kg^-1 dry mass) were: 2466, 8873, 9323, and 436 in the placenta; 957, 6173, 26,757, and 326 in the umbilical cord, and 1252, 7460, 13,562, and 370 in the fetal membrane. In the studied materials from northwestern Poland, we found strong positive correlations between Ca and Mg concentrations in both the umbilical cord (r = 0.81, p = 0.00) and the fetal membrane (r = 0.73, p = 0.00); between K and Mg concentrations in the umbilical cord (r = 0.73, p = 0.00); between Ca and K concentrations in the fetal membrane (r = 0.73, p = 0.00), and we found moderately positive correlations between placental Ca concentration and placental weight (ρ = 0.42, p = 0.00) and between umbilical cord Mg concentrations and the length of the pregnancy (ρ = 0.42, p = 0.00). Negative correlations were found between Na and Ca concentrations in the fetal membrane (r = -0.40, p = 0.00) and Na concentrations in the fetal membrane and Mg concentrations in the placenta (r = -0.16, p = 0.02). Negative correlations were confirmed between the length of pregnancy and head circumference (ρ = -0.42; p = 0.00), infant weight (ρ = -0.42; p = 0.00), infant length (ρ = -0.49; p = 0.00), shoulder width (ρ = -0.49; p = 0.00); and between the infant weight and head circumference (ρ = -0.62; p = 0.00), weight before delivery (ρ = -0.36; p = 0.00), infant length (ρ = -0.45; p = 0.00), shoulder width (ρ = -0.63; p = 0.00), and weight gain during pregnancy (ρ = -0.31; p = 0.01). We found statistically significant correlations between cigarette smoking before pregnancy and the women's weight before delivery (ρ = 0.32, p = 0.00), and a negative correlation between the women's ages and infant head circumference (ρ = -0.20, p = 0.02). This is probably the first study to evaluate Ca, Na, K, and Mg concentrations in the afterbirth tissues of multiple pregnancies. It adds to the knowledge of elemental concentrations in multiple pregnancies and their possible effects on fetal morphometric parameters.