Magnesium Low

Answering Nazek:
Disorders of Magnesium Balance (1)
Introduction Magnesium is the most abundant intracellular divalent cation and, after calcium, the most common divalent cation in the body. The majority (99%) of magnesium residing inside cells. Consequently, plasma magnesium concentration does not reflect total body magnesium. Magnesium plays an important role in neuromuscular coupling, largely through its interaction with calcium. Disorders of magnesium primarily reflect hypomagnesemia, with cardiac arrhythmias and other features similar to those of low calcium. Among the causes of hypomagnesemia are malnutrition, chronic alcoholism, kidney abnormalities and malabsorption. [Is she taking any laxatives?]
Magnesium Intake and Distribution Magnesium is found in many foods, including green vegetables and meat products, and the normal diet is usually more than ample. Approximately 5 mg/kg per day of magnesium is required for normal magnesium balance. Factors that control gastrointestinal magnesium absorption are unclear, but about one-third of ingested magnesium is absorbed.
Magnesium Excretion The distal nephron (part of the kidney), however, is the major site of fine regulation of magnesium excretion. Loop-acting diuretics predictably have a potent magnesium-wasting effect. [Is she taking any ‘Water Pills?], [One-Alpha should only be given to patients suffering from kidney disease. Is that the case here?]
Role of Magnesium The major role of magnesium is as a cofactor for hundreds of identified enzymes that produce or require ATP, such as kinases, ATPase, and adenylyl cyclase. Disorders of magnesium may lead to impaired energy production, substrate utilization, and synthetic processes.
Hypomagnesemia (Low magnesium) ESSENTIALS OF DIAGNOSIS
• Plasma [Mg2+] <1.7 style="color: rgb(255, 102, 102);">The numbers given satisfy this criterion.] • Cardiac arrhythmias, refractory potassium deficiency. [What was her potassium level?] • Features suggestive of hypocalcemia: tetany, weakness, increased deep tendon reflexes, altered mental status, and seizures. [Are there any symptoms like these?]
[Please provide also the laboratory reference levels for any result mentioned as this varies between laboratories.]
References
1. Bongard FS, STAT!Ref, Teton Data Systems. Current critical care diagnosis & treatment. 3rd ed. New York ;London: McGraw-Hill; 2008.

[Above doesn’t replace the input of a medical professional who interviews the patient and carries out a physical examination followed by a discussion of care – that is the premier method of obtaining medical advice at this time of medical science development].

Sleep Deprivation

My son’s friend expressed some medical concerns about sleep as follows:

"After a grueling term in school, entailing 14 weeks of little to no sleep, she slept around 15 hours a night for 3 days. She was fine until the 3rd day as she was hit with major dizziness. She thought it might've been low blood pressure so she started downing candy and sweets but that didn't help. After 2 or so weeks of trying different sleep patterns: forcing herself to sleep 5 hrs a night, or 8 hrs, or 10... It got better but it's still lingering."

Dear young lady,

Those 14 weeks of sleep deprivation are very detrimental to your health for the following reasons:

· You disorganized your natural sleeping rhythm which is regulated around the light and dark cycle of the day.[1]

· You decreased the opportunity for your body to produce many necessary hormones efficiently which are required for your well-being. Specifically growth hormone, thyroxin and increased other hormones such as cortisol putting your body in a ‘hyper-alert mode’ which is unsustainable long term.

· You increased your risk of hypertension[2-4], diabetes[5], depression[6], cancer[7], coronary artery disease[8-10], obesity[11], and increased risk of death[12].

· You decreased your ability to retain knowledge[13].

· And so on.

I believe you are getting the point I am trying to make. Sleep is too important to ignore. Please see the chapter on sleep for more information.

The dizziness happened because your brain chemicals, brain hormones, neurotransmitters and body hormones were in disarray so you had a lot of melatonin lingering around trying to get you to sleep and all the other systems were off whereby your serotonin was on the low side and trying to catch up and get back into a synchronized organized balance. (This paragraph is an assumptive description as to date we can't say definitively how exactly all these phenomena transpire).

The return to a good balance is by maintaining a lifelong 8 – 9 hours of sleep regularly every night and that is better if implemented at the same time every night.

The lingering of the dizziness for you should not last too much longer because I am under the assumption you are close in age to my son and in basically good health. Caution: if you continue doing the “sleep deprivation thing” you will exhaust your reserves and possibly end up with depression or fibromyalgia.

Oh, and by the way, the candy or sweets will just perpetuate the whole condition and increase the possibility of some of the risks I described above.

I am surprised you didn’t also have a headache during your recuperation.

I hope you get better soon. [Above doesn’t replace the input of a medical professional who interviews the patient and carries out a physical examination followed by a discussion of care – that is the premier method of obtaining medical advice at this time of medical science development].

DA Jan. 10, 2010

References

1. Wyatt JK, Cecco AR-D, Czeisler CA, Dijk D-J. Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day. Am J Physiol Regul Integr Comp Physiol. 1999 October 1, 1999;277(4):R1152-63.

2. Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey. Hypertension. 2006 May 1, 2006;47(5):833-9.

3. Goncharuk VD, Heerikhuize JV, Dai J-P, Swaab DF, Buijs RM. Neuropeptide changes in the suprachiasmatic nucleus in primary hypertension indicate functional impairment of the biological clock. The Journal of Comparative Neurology. 2001;431(3):320-30.

4. Cappuccio FP, S. Stranges, et al. Gender-Specific Associations of Short Sleep Duration With Prevalent and Incident Hypertension: The Whitehall II Study. Hypertension. October 2007;50(4):693-700.

5. van Cauter E, U. Holmbäck, et al. Impact of Sleep and Sleep Loss on Neuroendocrine and Metabolic Function. Hormone Research. 2007;67(Suppl. 1):2-9.

6. Vgontzas AN, Bixler EO, Lin H-M, et al. Chronic Insomnia Is Associated with Nyctohemeral Activation of the Hypothalamic-Pituitary-Adrenal Axis: Clinical Implications. J Clin Endocrinol Metab. 2001 August 1, 2001;86(8):3787-94.

7. McClain J. Association between physical activity, sleep duration, and cancer risk among women in Washington County, MD: A prospective cohort study., 2008.

8. Liu Y, Tanaka H. Overtime work, insufficient sleep, and risk of non-fatal acute myocardial infarction in Japanese men. Occup Environ Med. 2002 July 1, 2002;59(7):447-51.

9. Schwartz S, W. M. Anderson, et al. Insomnia and heart disease: a review of epidemiologic studies. Journal of Psychosomatic Research. 01-OCT-1999;47(4):313-33.

10. Shankar A, W.-P. Koh, et al. Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study. Am J Epidemiol. 2008;168(12):1367-73.

11. Spiegel K, Tasali E, Penev P, Cauter EV. Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite. Ann Intern Med. 2004 December 7, 2004;141(11):846-50.

12. PATEL SR, N. T. AYAS, et al. A Prospective Study of sleep duration and mortality risk in women. Sleep. 2004;27(3):440-4.

13. Grunstein R. Insomnia. Diagnosis and management. Aust Fam Physician. 2002;31:1-6.