Triglyceride-glucose index (TyGI) is a novel biomarker for diagnostic and prognostic processes. TyGI, together with magnesium level and The Charlson Comorbidity Index (CCI; used to predict long-term survival), is associated with morbidity and mortality. As type 2 diabetes mellitus (T2DM) is associated with hypomagnesaemia, magnesium may therefore be related to TyGI and CCI in patients with T2DM. To compare hypomagnesemia and normomagnesemia in terms of TyGI and CCI, and to investigate the correlation of magnesium with TyGI and CCI in patients with T2DM. T2DM patients (n=194) were divided into hypomagnesaemia (n=58) and normomagnesaemia (n=136) groups depending on serum magnesium level. TyGI was calculated with the formula, Ln[fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2]. TyGI, CCI, and laboratory parameters were compared between the groups. Correlation analysis was performed between magnesium and other parameters. There was no significant difference between the groups in terms of age, gender, BMI, T2DM duration, medication, comorbidities, or laboratory parameters (p>0.05). However, the hypomagnesaemia group had significantly increased TyGI (p=0.014) and CCI (p=0.044). There was also a significant negative correlation between magnesium and parameters including T2DM duration (r:-155; p=0.031), glucose (r:-214; p=0.003), HbA1c (r:-195; p=0.007), TyGI (r:-0.207; p=0.004), and CCI (r:-0.177; p=0.014). TyGI and CCI are increased in T2DM patients with hypomagnesaemia, and magnesium is associated with TyGI and CCI. These novel findings should be further investigated in future studies.
The objective of this study was to investigate the effects of intravenous magnesium sulfate (MgSO4) administration on core body temperature (BT) changes in patients undergoing laparoscopic gynaecological surgery under propofol-based total intravenous anaesthesia (TIVA). Data from 120 female patients, aged 20-65, who underwent laparoscopic gynaecological surgery between March 2021 and February 2024, were analysed retrospectively. Patients were divided into Mg (n=49) and non-Mg (n=71) groups. The Mg group received MgSO4 (50 mg/kg in 100-mL isotonic saline over 15 minutes) during induction, followed by a continuous infusion (15 mg/kg/h). Core BT was recorded using tympanic thermometer and oesophageal probes: pre-anaesthesia (BT0), 5 minutes post-induction (BT5), every 15 minutes (BT15 ~ BT105), and at emergence (BT120). All patients were warmed using both a circulating-water mattress and a forced-air warming blanket. BT0 was comparable between groups. BT decreased over time in both groups (p < 0.001). The Mg group had significantly lower BT at BT5 (p = 0.031), BT15 (p = 0.004), BT30 (p = 0.011), and BT45 (p = 0.016). However, the rate of temperature change over time between groups was comparable. The incidence of post-anaesthetic shivering was significantly lower in the Mg group (19.7% vs 6.1%, p = 0.036). During propofol-based TIVA, MgSO4 administration reduced BT at early time points during surgery, while the rate of temperature change over time was not significantly affected by MgSO4 administration. Notably, the incidence of shivering was significantly lower in the Mg group.
Studies on magnesium and bone health in the literature are conflicting. This study was conducted to evaluate the relationship between Magnesium Deficiency Score (MDS) and indicators of hip bone health in adults. This study analysed data from the NHANES in 13,259 US adults aged ≥20 years. Outcome measures included bone mineral density (BMD) (total femur, femoral neck, trochanter, intertrochanter, and Ward's triangle), osteoporosis, history of hip fracture, and FRAX (Fracture Risk Assessment Tool) score. Weighted linear regression and logistic regression models were used to assess the association between MDS and the outcomes. Trend tests were also performed to analyse the presence of a dose-response relationship. Subgroup analyses were performed by age and sex. After adjusting for all covariates, we found a significant age-stratified effect between MDS and hip bone health. In the elderly population aged ≥60 years, there was a higher risk of decline in Ward's triangle and femoral neck BMD, a higher risk of osteoporosis (OR =1.27, 95% CI: 1.07, 1.50; P trend =0.006), and higher FRAX scores as MDS scores increased. However, this negative effect was significantly attenuated in individuals <60 years. No association was found between MDS and a history of hip fracture. In addition, no sex-stratified effect was found between MDS and the outcome measures described above. The risk of severe magnesium deficiency significantly affects hip bone health in older adults, increasing the risk of subsequent fractures. Future studies should explore more detailed mechanisms associated with the role of magnesium in skeletal physiology and pathology.
Hypomagnesemia, a common condition, frequently goes unnoticed due to varying symptom severity. In the hospital setting, the link between adverse drug reactions and hypomagnesemia is not always clear, and some drug labels omit this risk, compounding the potential danger. We conducted a cross-sectional study by mining data from the FDA Adverse Event Reporting System (FAERS) covering Q1 2004 to Q4 2023. Using the Medical Dictionary for Regulatory Activities, we identified cases of hypomagnesemia, determined the signal drugs causing hypomagnesemia based on the drug name, and employed descriptive and disproportionality analysis methods for signal detection. From 17,381,220 adverse event reports, 11,228 individual safety reports (ISRs) involving hypomagnesemia were identified. Omeprazole led with 1,556 reports (20.75%), followed by pantoprazole, panitumumab, cetuximab, and esomeprazole. Disproportionality analysis revealed necitumumab as the drug with the strongest signal, followed by capreomycin, panitumumab, pantoprazole, and omeprazole. Among the top 50 drugs from the disproportionality analysis, 31 signal drugs had labels that did not mention the risk of hypomagnesemia. We issue warnings regarding drugs associated with specific combination therapies that cause adverse reactions leading to hypomagnesemia. Furthermore, to delve deeper into the relationship between drugs and hypomagnesemia, reliance on more credible research in this field is required.
The role of magnesium supplementation in reducing the risk of gestational diabetes (GD) has not been elucidated. To evaluate the effect of magnesium chloride (MgCl2) on the risk of developing GD in a model of obese rats with hydrochlorothiazide-induced hypomagnesemia. Female Wistar rats were allocated into a healthy control or obese group. Obesity was induced with an obesogenic diet and defined by a body weight 30% higher than that of the healthy control group. Once obesity was induced and before pregnancy, hypomagnesemia was generated using hydrochlorothiazide (5 mg/kg body weight). Subsequently, the oestrous cycle was evaluated to proceed for mating. Once pregnancy was confirmed, the obese rats were allocated to an intervention group (IG) or control group (HOCG). Rats in the IG received MgCl2 (50 mg/kg body weight, equivalent to 500 mg per day in humans). Fasting glucose and ionized magnesium levels were determined on days 6, 15, and 20 of pregnancy. An oral glucose tolerance test was performed on day 15 of pregnancy. Rats in the IG had significantly increased ionized magnesium (p=0.009), decreased fasting (p=0.02) and two-hour post-load (p=0.04) glucose levels, and exhibited lower body weight gain than the HOCG (p<0.05). At the end of the study, 75% of the rats in the HOCG, but none in the IG, fulfilled the diagnostic criteria for GD. In obese hypomagnesaemic rats, magnesium supplementation, using MgCl2, reduces fasting and two-hour post-load glucose levels as well as the risk of developing GD, and induces lower body weight gain during pregnancy.
Magnesium has been used as an adjuvant to general anaesthesia owing to its multiple benefits, including potentiating the action of rocuronium. However, magnesium may affect neostigmine-induced neuromuscular blockade recovery. The effects of intraoperative magnesium administration on residual neuromuscular blockade (RNMB) were investigated. This retrospective study reviewed the data of adult patients who underwent general anaesthesia with rocuronium as the neuromuscular blocking agent and neostigmine as the reversal agent, between 2018 and 2020. RNMB was defined as the administration of an additional reversal agent (neostigmine or sugammadex) in the post-anaesthesia care unit. The incidence of RNMB was compared between magnesium and control groups, and logistic regression analysis identified risk factors. Of 61,471 patients, 23,523 were included in the logistic regression analysis. After propensity score matching, 5166 patients from each group were compared, and RNMB incidence was comparable between the magnesium and control groups. In the logistic regression analysis, the risk factors for RNMB were older age (odds ratio: 1.02; 95% confidence interval: 1.01-1.03; p<0.001), male gender (1.72; 1.33-2.23; p<0.001), higher American Society of Anesthesiologists physical status (2.08; 1.54-2.82; p<0.001), limb surgery (1.46; 1.01-2.12; p=0.042), volatile anaesthetics, sevoflurane (1.84; 1.27-2.66; p=0.001), and intraoperative hypothermia (1.58; 1.13-2.23; p=0.008). Magnesium increased the risk of RNMB in patients anesthetized by propofol (2.22; 1.46-3.38; p<0.001) and sevoflurane (2.57; 1.60-4.11; p<0.001), but not desflurane (p≥0.05). Intraoperative magnesium increases the risk of RNMB in patients anesthetized with propofol and sevoflurane, and should be used with caution depending on the type of general anaesthetic agent administered.
Hypomagnesemia is significantly more frequent in acute pancreatitis (AP) patients. Magnesium sulfate is a routine drug used in clinical practice to treat hypomagnesemia. This study aimed to explore the association between magnesium sulfate administration and short-term mortality among intensive care unit (ICU)-admitted AP patients. Data of this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) and MIMIC-IV database. The exposure was magnesium sulfate administration during the ICU stay. The primary outcome was 30-day mortality. The secondary outcome was in-hospital mortality. The weighted univariate and multivariate cox proportional hazard models were utilized to explore the association between magnesium sulfate administration and 30-day mortality and in-hospital mortality among ICU-admitted AP patients, based on hazard ratios (HRs) and 95% confidence interval (CIs). Subgroup analyses were conducted based on different age, gender, scoring systems and complications. A total of 1,924 AP patients were included. Of these, 1,334 (69.33%) received magnesium sulfate administration. After adjustment for all covariates, magnesium sulfate administration was associated with a lower risk of 30-day mortality (HR=0.49, 95%CI: 0.36-0.66) and in-hospital mortality (HR=0.42, 95% CI: 0.31-0.57) among ICU-admitted AP patients. This association remained robust when subgroup analyses were conducted based on age, gender, history of hypomagnesemia, heart failure, hypertension, diabetes, liver disease, acute kidney injury and sepsis, and Bedside Index of Severity of Acute Pancreatitis (BISAP) and Charlson Comorbidity Index (CCI). The administration of magnesium sulfate may have potential benefits in improving the short-term prognosis of ICU-admitted AP patients.
Magnesium is an essential electrolyte, regulating enzymatic function and membrane excitability. While dysmagnesaemia is common among hospitalized patients, its prognostic role and the potential clinical benefit of its correction remain debated. METHODS:All adult patients admitted to internal medicine wards at the Tel-Aviv Sourasky Medical Center between June 1st, 2007, and July 31st, 2022, for whom magnesium levels were measured, were included. Data from 85,466 patients were obtained. Patients were divided into four subgroups according to magnesium level at admission: severe hypomagnesaemia (serum magnesium ≤1.2mg/dL), mild hypomagnesaemia (magnesium >1.2mg/dL≤1.8mg/dL), eumagnesaemia (magnesium >1.8/≤2.55mg/dL), and hypermagnesaemia (magnesium >2.55). The primary outcome was 30-day mortality risk. RESULTS:Hypomagnesaemia was associated with the use of thiazides and proton pump inhibitors (p<0.001), while severe hypermagnesaemia was associated with reduced renal function (p<0.001). After adjusting for age, gender, the Charlson comorbidity index, creatinine, potassium, and calcium corrected for albumin, mild hypomagnesaemia was associated with lower 30-day mortality (HR: 0.87, 95% CI: 0.82-0.93, p<0.001), hypermagnesaemia was associated with higher 30-day mortality (HR: 2.86, 95% CI: 2.57-3.17, p<0.001), and severe hypomagnesaemia was not associated with survival change (HR: 0.82, 95% CI: 0.62-1.09, p=0.177). Hypermagnesaemia normalization (HR: 0.77, 95% CI: 0.63-0.93, p<0.001) and administration of magnesium supplements for mild (adjusted HR: 0.53, 95% CI: 0.36-0.79, p=0.002) or severe (HR: 0.34, 95% CI: 0.28-0.41, p<0.001) hypomagnesaemia were associated with reduced mortality. CONCLUSION:In hospitalized, non-critically ill medical patients, hypermagnesaemia confers a substantial 30-day mortality risk, which may be mitigated by its correction. Although hypomagnesaemia is not associated with worse outcome, its correction by supplementation may be of clinical benefit.
Orthopaedic implant-related infections (IRIs) are severe postoperative complications that are difficult to clear by debridement or antibiotic treatments. Magnesium oxide (MgO) effectively inhibits or kills a broad spectrum of bacteria, is minimally associated with safety issues, and poses no risk of inducing antibiotic resistance. Therefore, MgO has been actively studied for environmental, hygienic, as well as clinical applications such as the management of IRIs. This narrative review discusses the antibacterial properties of MgO, related mechanisms, and recent studies related to orthopaedic IRIs. Existing problems and potential possibilities for further research are also suggested.
Total serum magnesium concentration is rarely determined in clinical practice. Moreover, there is currently no standardised and evidence-based reference range for serum magnesium. The aim of this communication is to propose a reference range that is evidence-based and reflects the preventive potential of optimal magnesium levels. A literature search was conducted in the PubMed database using the terms "serum magnesium", "reference interval", "reference range", and "hypomagnesemia". Additionally, citations from relevant studies were consulted. There is considerable variation between laboratories with regards to the lower limit of magnesium in serum. The majority of limits are considerably below the 0.85 mmol/L (2.07 mg/dL) threshold proposed by expert groups. The rationale for this limit is that lower levels are associated with an increased risk of diseases such as type 2 diabetes and cardiovascular diseases. To prevent health risks associated with low magnesium levels, the lower limit of serum magnesium should be raised to 0.85 mmol/L and standardised between laboratories. At least, laboratory reports should note that levels below 0.85 mmol/L are associated with an increased risk of disease. Furthermore, the determination of serum magnesium should be afforded the same importance in routine laboratory diagnostics as the determination of other electrolytes.
Hyperuricemia is associated with an increased risk of mortality in coronary heart disease (CHD) patients. Magnesium intake is related to reduced mortality due to cardiovascular disease. This study aimed to investigate the association between dietary magnesium intake, magnesium depletion score (MDS) and hyperuricemia-related all-cause mortality or cardiovascular mortality in patients with CHS. In this retrospective cohort study, 1,823 CHD patients were selected from the National Health and Nutrition Examination Survey (NHANES). Dietary magnesium intake was determined based on 24-hour dietary recall interviews. MDS was assessed considering four factors: use of diuretics, use of proton pump inhibitors, estimated glomerular filtration rate, and alcohol consumption. Weighted univariate and multivariate Cox regression models were applied to explore the association between dietary magnesium intake, MDS, hyperuricemia, and all-cause mortality or cardiovascular mortality. The results were presented as hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan-Meier survival curves were used to explore survival status relative to magnesium intake or MDS. After an average of 81 months of follow-up, 879 CHD patients died. After adjusting for covariates, MDS ≥2 (HR=1.34, 95% CI: 1.13-1.60) and hyperuricemia (HR=1.25, 95% CI: 1.01-1.55) were associated with increased odds of all-cause mortality. Moreover, MDS affected the association between hyperuricemia and all-cause mortality (HR=1.41, 95% CI: 1.09-1.84) or cardiovascular mortality (HR=1.44, 95% CI: 1.02-2.03) in CHD patients. MDS influences mortality in patients with hyperuricemia, highlighting the potential importance of magnesium status in managing the risks associated with hyperuricemia in CHD patients.
Objective: Alterations in the metabolism of calcium and the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Serum magnesium concentrations only insufficiently reflect disorders in magnesium handling in humans, as only about 1% of total body magnesium stores are in blood. The calcium and magnesium flux across the external membrane is regulated by a calcium pump (calcium-magnesium-ATPase), calcium and magnesium (TRPM 6 and 7) channels and a sodium magnesium antiport. An increased calcium-magnesium ratio is known to be involved in the development of atherosclerosis. Early onset of this disorders are known in hypertension. Design and method: We present a study in 18 hypertensive elderly concerning ionized magnesium concentrations and ionized calcium-magnesium ratio in blood measured by a Prime Plus apparatus by NOVA Medical, Andover, USA. Results: In 18 elderly hypertensives (9 male/9 female with normal renal function) ionized magnesium was measured 0.55 +/- 0.04 mmol/l (normal range: 0.54 - 0.80 mmol/l). The ionized calcium-magnesium ratio was 2.33 +/- 0.18 (normal range below 2.40)(p< 0.05). Data are means +/- SD. ANOVA was used for statistical evaluation. About 40% of elderly hypertensives showed an significantly increased ratio of ionized calcium and magnesium, which is well known to be a marker for the development of arteriosclerosis. Conclusions: As described earlier, a deficiency in the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Ionized magnesium data, as presented here, are rare, but ionized magnesium is the active magnesium in the body regulating about 600 enzymatic reactions. The significantly increased ratio of ionized calcium and magnesium is important in the development of arteriosclerosis often resulting in stroke or heart insufficiency in hypertension.
Ischemia/reperfusion (I/R) injury is a main issue in renal transplantation, and antioxidants attenuate I/R injury in different tissues. We investigated the protective effects of nano magnesium oxide (nano-MgO) on renal I/R injury in rats. Induction of I/R injury was performed through clamping the left renal pedicle for 20 minutes. Animals were administrated with nano-MgO (1.25, 2.5 and 5 mg/kg) for 30 days by gavage, and were sacrificed for biochemical and histopathological studies. Our findings show that nano-MgO administration (2.5 and 5 mg/kg) in rats with renal I/R injury significantly attenuated serum creatinine and urea levels (p<0.001), decreased malondialdehyde (MDA) levels and elevated antioxidant enzyme activities in renal homogenates (p<0.001), as evidenced by histopathological assessment, and caused a significant reduction in EGF immunoreactivity and EGFR expression in renal tissues (p<0.001). In conclusion, nano-MgO administration preserves renal function and prevents tissue damage after I/R injury in rats.
Although intraoperative magnesium sulphate administration has various advantages, its influence on the occurrence of postoperative acute kidney injury (AKI) remains unclear, particularly in patients undergoing robot-assisted radical prostatectomy (RARP). The steep Trendelenburg position and a high intra-abdominal pressure can render patients susceptible to AKI after surgery. This study aimed to evaluate the effects of intraoperative magnesium sulphate administration on postoperative AKI in patients who underwent RARP. This retrospective study used a propensity score-matched analysis to evaluate the medical records of patients who underwent RARP between May 2013 and December 2021 in a single institution. In total, 3,239 cases were reviewed. After propensity score matching, 456 patients were each included in the magnesium and control groups. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for postoperative AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within seven days after surgery. The incidence of postoperative AKI did not differ significantly between the magnesium and control groups (30.7% versus 31.4%). The univariate logistic regression analysis revealed that intraoperative magnesium sulphate administration was not associated with AKI after RARP (p=0.83). In the multivariate analysis, body mass index (odds ratio [OR], 1.069; p=0.018) and duration of surgery (OR, 1.005; p=0.027) were independent risk factors, while total intravenous anaesthesia (OR, 0.448; p=0.005) and intraoperative fluid replacement (OR, 0.856; p=0.012) were protective factors for postoperative AKI. Intraoperative magnesium sulphate administration had no significant effect on the occurrence of postoperative AKI in patients undergoing RARP.
Individuals with long-COVID exhibit a higher frequency of hypomagnesemia, vitamin D deficiency, and depression. Objective. To evaluate the efficacy and safety of oral supplementation with magnesium chloride plus vitamin D in alleviating depressive symptoms related to long-COVID. A total of 60 subjects, aged 52.8±12.6 years, with a diagnosis of hypomagnesemia, vitamin D deficiency, and mild-to-moderate depression (MMD) related to long-COVID, were enrolled in an open-label randomized, controlled clinical trial. Participants were randomly allocated into an intervention group (n=30) that received magnesium chloride (1300 mg) plus vitamin D (4000 IU), or a control group (n=30) that received vitamin D (4000 IU), for four months. Using the Beck Depression Inventory (BDI), diagnosis of MMD was established based on a score of ≥11<30. The primary trial endpoint was improvement in depressive symptoms (BDI <11). Mild adverse events that did not require withdrawal from intervention were documented in six (20.0%) and three (10%) individuals of the intervention and control group, respectively. By comparing baseline vs. final measurements, the BDI score was significantly reduced in individuals in the intervention (28.8±3.7 to 9.2±7.5, p<0.01) and control (28.4±3.8 to 21.6±9.1, p<0.05) group. A total of 22 (73.2%) subjects in the intervention group and 10 (34.5%) in the control group reached a BDI <11, p=0.006. Our results show that, among patients with hypomagnesemia and vitamin D deficiency, combined oral supplementation with magnesium plus vitamin D is effective and safe in alleviating MMD related to long-COVID.
This study aimed to explore the association between serum vitamin D and/or dietary magnesium intake levels and severe hepatic steatosis. This cross-sectional study collected data from 2,874 individuals in the NHNAES database between 2017 and 2018. Variables were subjected to weighted univariate logistic regression analysis, and variables with p<0.05 were selected for weighted multivariate logistic regression analysis. The stepwise backward method was then used, and variables with p<0.05 in the weighted multivariate logistic model were retained as confounding factors. Univariable and multivariable logistic regression models were applied to explore the effect of magnesium intake and/or vitamin D level on the risk of hepatic steatosis in overweight and obese individuals. Subgroup analysis was stratified by age, gender, BMI, and complications. The respective odds ratio (OR) and confidence interval (CI) were calculated. The risk of severe hepatic steatosis in overweight and obese individuals was increased in those with deficient serum vitamin D levels (OR: 1.71, 95% CI: 1.13-2.57). No significant correlation between dietary magnesium intake level and severe hepatic steatosis was observed in overweight and obese individuals (all p>0.05). However, an increased risk of severe hepatic steatosis in overweight and obese individuals was found in those with deficient dietary magnesium intake and deficient serum vitamin D compared to those with sufficient serum vitamin D (OR: 1.86, 95% CI: 1.20-2.89). Deficient magnesium intake in overweight and obese patients with low serum vitamin D levels may increase the risk of severe hepatic steatosis, however, future studies are required to verify our findings.
Impulsive behaviours affect patients with major depressive disorder (MDD) and bipolar disorder (BP), increasing suicide risk and mood instability. Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist, has been reported to promote fast-acting antidepressive and antisuicidal effects. Magnesium administered contemporarily with low-dose NMDA antagonists has been shown to cause a reduction in anxiety-related and depressive-like behaviours. This observational study investigated the possible association between magnesium levels and impulsivity, measured using the Barratt Impulsiveness Scale (BIS-11), during ketamine treatment. Forty-nine inpatients with treatment-resistant mood disorders were involved in the study. The study therapeutic intervention was based on the administration of eight ketamine intravenous infusions over four weeks. The BIS-11 and magnesium levels were assessed for every subject before the first, third, fifth and seventh ketamine infusion and one week after the last infusion. The concentration of magnesium ions during the ketamine treatment was not associated with BIS-11 changes. The study does not provide evidence for a relationship between magnesium concentration and impulsivity, measured using the BIS-11, during ketamine treatment.
Low magnesium (Mg) intake increases the risk of various diseases such as anxiety disorder, depression, and diabetes. However, a reliable biomarker of mild Mg deficiency due to low Mg intake has not yet been identified. We speculate that metabolomics will be effective for biomarker discovery because Mg can affect various metabolic processes in the body. In the present study, we evaluated whether mild Mg deficiency affects growth, behaviour, and plasma and urinary metabolomes in rats. Mg levels in plasma and the femur, and urinary Mg excretion decreased by consuming a mildly low Mg diet, whereas body weight and food intake were not affected. Also, anxiety- and depression-like behaviours were not affected by Mg deficiency. These results indicate that the negative effects observed here are milder than those for severe Mg deficiency, as previously reported. Of the 93 annotated metabolites in plasma, only glycylglycine was moderately affected. Of the 122 annotated metabolites in urine, 29 were affected. A marked decrease in urinary excretion of some organic acids of the tricarboxylic acid cycle, particularly citric acid, was noticed. This study identifies urinary metabolites that may be useful biomarkers of mild Mg deficiency.
