Dear All
I would very much appreciate some ideas regarding the
following patient I have been asked about
Problem = recurrent low serum magnesium
Jan 2010
Mg = 0.38 mmol/L ref 0.7-1 (normal albumin)
PO4 = 0.31 mmol/L ref 0.8-1.5 treated with PO4 iv.
Past Hx of excessive intake of alcohol but stopped this
6/12 prior to blood test (now max = 1 bottle wine/week)
Diagnoses
1. Iron deficiency anaemia OGD = hiatus hernia
2. Wt loss now stabilised CT chest and abdo = not
remarkable
3. DM on metformin (HbA1c = 5.4%)
4. Recurrent chest pain
Medication now =
Ramipril
Atenolol
Nicorandil
Ondansetron
Clopidogrel
Pantoprazole
Cyclizine
Metformin
Mirtazapine
Amlodipine
Atorvastatin
Cetirizine
No evidence of GI losses resulting in low magnesium
No past history of chemotherapy
Not taking laxatives
PPI was stopped for a few weeks (had ranitidine instead)
due to PPIs sometimes being associated with a low Mg but
due to melaena developing had to be put back on to PPI.
I was wondering about possible causes of low Mg being
Dietary / malabsorption / renal loss
Biochemical investigations -
24hr urine Mg = 4.43 mmol (was having a Mg infusion during
this time 20 mmol iv over 12hrs)
When not having Mg infusion random urine
Urine Mg = 0.7 mmol/L
Urine Ca = 1.4 mmol/L
Urine Creatinine = 0.9 mmol/L
Urine Calcium:creatinine ratio = 1.56
Other blood results
Renin = 0.6 nmol/L/hr
Aldosterone = 110 pmol/L
Vit D = 48 nmol/L
Calcium and PTH = normal
B12, folate, CRP = normal
U+E = mild renal impairment (K= 5.0 mmol/L)
Currently having to have several Mg infusions each month
Today, blood results Mg = 0.42 mmol/L
PO4 = 0.82 mmol/L
Ca = 2.39 mmol/L
Many thanks
Rob
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