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. 1990 Feb;152(2):145–148.

Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia.

E Ryzen 1, R K Rude 1
PMCID: PMC1002289  PMID: 2407029

Abstract

To determine the role of magnesium deficiency in the pathogenesis of hypocalcemia in acute pancreatitis, we measured magnesium levels in serum and in peripheral blood mononuclear cells in 29 patients with acute pancreatitis, 14 of whom had hypocalcemia and 15 of whom had normal calcium levels. Only six patients had overt hypomagnesemia (serum magnesium less than 0.70 mmol per liter [1.7 mg per dl]). The mean serum magnesium concentration in hypocalcemic patients was not significantly lower than in normocalcemic patients, but the mononuclear cell magnesium content in hypocalcemic patients with pancreatitis was significantly lower than in normocalcemic patients with pancreatitis (P less than .01). The serum magnesium level did not correlate with that of serum calcium or the mononuclear cell magnesium content, but the latter did significantly correlate with the serum calcium concentration (r = .81, P less than .001). Most patients with hypocalcemia had a low intracellular magnesium content. Three normomagnesemic, hypocalcemic patients with alcoholic pancreatitis also underwent low-dose parenteral magnesium tolerance testing and showed increased retention of the magnesium load. We conclude that patients with acute pancreatitis and hypocalcemia commonly have magnesium deficiency despite normal serum magnesium concentrations. Magnesium deficiency may play a significant role in the pathogenesis of hypocalcemia in patients with acute pancreatitis.

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Selected References

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  1. Allgrove J., Adami S., Fraher L., Reuben A., O'Riordan J. L. Hypomagnesaemia: studies of parathyroid hormone secretion and function. Clin Endocrinol (Oxf) 1984 Oct;21(4):435–449. doi: 10.1111/j.1365-2265.1984.tb03230.x. [DOI] [PubMed] [Google Scholar]
  2. Anast C. S., Winnacker J. L., Forte L. R., Burns T. W. Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab. 1976 Apr;42(4):707–717. doi: 10.1210/jcem-42-4-707. [DOI] [PubMed] [Google Scholar]
  3. Bhattacharya S. K., Crawford A. J., Pate J. W., Clemens M. G., Chaudry I. H. Mechanism of calcium and magnesium translocation in acute pancreatitis: a temporal correlation between hypocalcemia and membrane-mediated excessive intracellular calcium accumulation in soft tissues. Magnesium. 1988;7(2):91–102. [PubMed] [Google Scholar]
  4. Canale D. D., Donabedian R. K. Hypercalcitoninemia in acute pancreatitis. J Clin Endocrinol Metab. 1975 Apr;40(4):738–741. doi: 10.1210/jcem-40-4-738. [DOI] [PubMed] [Google Scholar]
  5. Cohen L., Kitzes R. Magnesium sulfate and digitalis-toxic arrhythmias. JAMA. 1983 May 27;249(20):2808–2810. [PubMed] [Google Scholar]
  6. Condon J. R., Ives D., Knight M. J., Day J. The aetiology of hypocalcaemia in acute pancreatitis. Br J Surg. 1975 Feb;62(2):115–118. doi: 10.1002/bjs.1800620209. [DOI] [PubMed] [Google Scholar]
  7. Decaux G., Hallemans R., Mockel J., Naeije R. Chronic alcoholism: a predisposing factor for hypocalcemia in acute pancreatitis. Digestion. 1980;20(3):175–179. doi: 10.1159/000198437. [DOI] [PubMed] [Google Scholar]
  8. Desai T. K., Carlson R. W., Geheb M. A. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med. 1988 Feb;84(2):209–214. doi: 10.1016/0002-9343(88)90415-9. [DOI] [PubMed] [Google Scholar]
  9. Desai T. K., Carlson R. W., Thill-Baharozian M., Geheb M. A. A direct relationship between ionized calcium and arterial pressure among patients in an intensive care unit. Crit Care Med. 1988 Jun;16(6):578–582. doi: 10.1097/00003246-198806000-00002. [DOI] [PubMed] [Google Scholar]
  10. Dhingra S., Solven F., Wilson A., McCarthy D. S. Hypomagnesemia and respiratory muscle power. Am Rev Respir Dis. 1984 Mar;129(3):497–498. doi: 10.1164/arrd.1984.129.3.497. [DOI] [PubMed] [Google Scholar]
  11. EDMONDSON H. A., BERNE C. J., HOMANN R. E., Jr, WERTMAN M. Calcium, potassium, magnesium and amylase disturbances in acute pancreatitis. Am J Med. 1952 Jan;12(1):34–42. doi: 10.1016/0002-9343(52)90166-6. [DOI] [PubMed] [Google Scholar]
  12. Estep H., Shaw W. A., Watlington C., Hobe R., Holland W., Tucker S. G. Hypocalcemia due to hypomagnesemia and reversible parathyroid hormone unresponsiveness. J Clin Endocrinol Metab. 1969 Jun;29(6):842–848. doi: 10.1210/jcem-29-6-842. [DOI] [PubMed] [Google Scholar]
  13. Hauser C. J., Kamrath R. O., Sparks J., Shoemaker W. C. Calcium homeostasis in patients with acute pancreatitis. Surgery. 1983 Nov;94(5):830–835. [PubMed] [Google Scholar]
  14. Imrie C. W., Allam B. F., Ferguson J. C. Hypocalcaemia of acute pancreatitis: the effect of hypoalbuminaemia. Curr Med Res Opin. 1976;4(2):101–116. doi: 10.1185/03007997609109289. [DOI] [PubMed] [Google Scholar]
  15. Iseri L. T., Freed J., Bures A. R. Magnesium deficiency and cardiac disorders. Am J Med. 1975 Jun;58(6):837–846. doi: 10.1016/0002-9343(75)90640-3. [DOI] [PubMed] [Google Scholar]
  16. Jones J. E., Shane S. R., Jacobs W. H., Flink E. B. Magnesium balance studies in chronic alcoholism. Ann N Y Acad Sci. 1969 Aug 15;162(2):934–946. doi: 10.1111/j.1749-6632.1969.tb13022.x. [DOI] [PubMed] [Google Scholar]
  17. Martin H. E. Clinical magnesium deficiency. Ann N Y Acad Sci. 1969 Aug 15;162(2):891–900. doi: 10.1111/j.1749-6632.1969.tb13018.x. [DOI] [PubMed] [Google Scholar]
  18. McMahon M. J., Woodhead J. S., Hayward R. D. The nature of hypocalcaemia in acute pancreatitis. Br J Surg. 1978 Mar;65(3):216–218. doi: 10.1002/bjs.1800650323. [DOI] [PubMed] [Google Scholar]
  19. Peoples J., Eberlein T., Webster M. W. Prevention of hypocalcemia by administration of homologous plasma during experimental hemorrhagic pancreatitis in the pig. Am J Surg. 1977 Jan;133(1):42–45. doi: 10.1016/0002-9610(77)90190-8. [DOI] [PubMed] [Google Scholar]
  20. Ranson J. H., Rifkind K. M., Roses D. F., Fink S. D., Eng K., Spencer F. C. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69–81. [PubMed] [Google Scholar]
  21. Reinhart R. A. Magnesium metabolism. A review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med. 1988 Nov;148(11):2415–2420. doi: 10.1001/archinte.148.11.2415. [DOI] [PubMed] [Google Scholar]
  22. Robertson G. M., Jr, Moore E. W., Switz D. M., Sizemore G. W., Estep H. L. Inadequate parathyroid response in acute pancreatitis. N Engl J Med. 1976 Mar 4;294(10):512–516. doi: 10.1056/NEJM197603042941002. [DOI] [PubMed] [Google Scholar]
  23. Rude R. K., Oldham S. B., Sharp C. F., Jr, Singer F. R. Parathyroid hormone secretion in magnesium deficiency. J Clin Endocrinol Metab. 1978 Oct;47(4):800–806. doi: 10.1210/jcem-47-4-800. [DOI] [PubMed] [Google Scholar]
  24. Rude R. K., Oldham S. B., Singer F. R. Functional hypoparathyroidism and parathyroid hormone end-organ resistance in human magnesium deficiency. Clin Endocrinol (Oxf) 1976 May;5(3):209–224. doi: 10.1111/j.1365-2265.1976.tb01947.x. [DOI] [PubMed] [Google Scholar]
  25. Rude R. K., Singer F. R. Magnesium deficiency and excess. Annu Rev Med. 1981;32:245–259. doi: 10.1146/annurev.me.32.020181.001333. [DOI] [PubMed] [Google Scholar]
  26. Ryzen E., Elbaum N., Singer F. R., Rude R. K. Parenteral magnesium tolerance testing in the evaluation of magnesium deficiency. Magnesium. 1985;4(2-3):137–147. [PubMed] [Google Scholar]
  27. Ryzen E., Elkayam U., Rude R. K. Low blood mononuclear cell magnesium in intensive cardiac care unit patients. Am Heart J. 1986 Mar;111(3):475–480. doi: 10.1016/0002-8703(86)90051-7. [DOI] [PubMed] [Google Scholar]
  28. Ryzen E., Nelson T. A., Rude R. K. Low blood mononuclear cell magnesium content and hypocalcemia in normomagnesemic patients. West J Med. 1987 Nov;147(5):549–553. [PMC free article] [PubMed] [Google Scholar]
  29. Stewart A. F., Longo W., Kreutter D., Jacob R., Burtis W. J. Hypocalcemia associated with calcium-soap formation in a patient with a pancreatic fistula. N Engl J Med. 1986 Aug 21;315(8):496–498. doi: 10.1056/NEJM198608213150806. [DOI] [PubMed] [Google Scholar]
  30. Weir G. C., Lesser P. B., Drop L. J., Fischer J. E., Warshaw A. L. The hypocalcemia of acute pancreatitis. Ann Intern Med. 1975 Aug;83(2):185–189. doi: 10.7326/0003-4819-83-2-185. [DOI] [PubMed] [Google Scholar]
  31. Whang R., Flink E. B., Dyckner T., Wester P. O., Aikawa J. K., Ryan M. P. Magnesium depletion as a cause of refractory potassium repletion. Arch Intern Med. 1985 Sep;145(9):1686–1689. [PubMed] [Google Scholar]
  32. Whang R., Oei T. O., Aikawa J. K., Ryan M. P., Watanabe A., Chrysant S. G., Fryer A. Magnesium and potassium interrelationships, experimental and clinical. Acta Med Scand Suppl. 1981;647:139–144. doi: 10.1111/j.0954-6820.1981.tb02649.x. [DOI] [PubMed] [Google Scholar]
  33. Zaloga G. P., Chernow B. Hypocalcemia in critical illness. JAMA. 1986 Oct 10;256(14):1924–1929. [PubMed] [Google Scholar]

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