Magnesium deficiency

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  1. Occurs in 65% of patients in the ICU (the most underdiagnosed electrolyte abnormality in current medical practice)
  2. Underlying causes: diuretic therapy, antibiotics, digitalis, chemotherapy, alcohol abuse, MI, diabetes
  3. Clinical manifestations: usually accompanied by depletion of K, PO4, and Ca (NOTE: hypokalemia that accompanies Mg depletion can be refractory to K replacement if Mg is not also replaced)
    1. Mg is needed for proper function of membranes thus hypomagnesemia may cause arrhythmias
      1. It is particularly associated with torsades de pointes (polymorphous ventricular tachycardia)
    2. neurologic manifestations: altered mentation, seizures, tremors, hyperreflexia, ataxia, slurred speech, metabolic acidosis, excessive salivation, muscle spasms
  4. treatment: give MgSO4 or mag oxide
  5. NOTE: hypermagnesemia may manifest as hyporeflexia, prolonged AV conduction, and finally heart block
    1. treatment: hemodialysis or IV calcium gluconate
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