Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1982 Oct 23;285(6349):1157–1159. doi: 10.1136/bmj.285.6349.1157

Diuretic-associated hypomagnesaemia.

J Sheehan, A White
PMCID: PMC1500130  PMID: 6812785

Abstract

Clinically suspected hypomagnesaemia was confirmed in 21 patients over 12 months; all patients had been exposed to either short-term vigorous diuretic treatment or moderate-dosage long-term treatment. Magnesium depletion was compounded by a hospital diet surprisingly low in magnesium, a local soft water supply, and, in some patients, high alcohol intake. Common presenting symptoms included depression, muscle weakness, refractory hypokalaemia, and atrial fibrillation refractory to digoxin treatment. The administration of magnesium supplements resulted in prompt improvement of all symptoms particularly in the case of refractory atrial fibrillation. Chronic low-grade magnesium deficiency from diuretic treatment is more common than published reports suggest. Older patients are at risk, particularly those who have excessive alcohol intake, a diet low in magnesium, or a soft water supply.

Full text

PDF
1157

Images in this article

1158FIG 1
on p.1158
1158FIG 2
on p.1158

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson T. W., Le Riche W. H., MacKay J. S. Sudden death and ischemic heart disease. Correlation with hardness of local water supply. N Engl J Med. 1969 Apr 10;280(15):805–807. doi: 10.1056/NEJM196904102801504. [DOI] [PubMed] [Google Scholar]
  2. Chadda K. D., Lichstein E., Gupta P. Hypomagnesemia and refractory cardiac arrhythmia in a nondigitalized patient. Am J Cardiol. 1973 Jan;31(1):98–100. doi: 10.1016/0002-9149(73)90818-7. [DOI] [PubMed] [Google Scholar]
  3. Crawford M. D., Gardner M. J., Morris J. N. Cardiovascular disease and the mineral content of drinking water. Br Med Bull. 1971 Jan;27(1):21–24. doi: 10.1093/oxfordjournals.bmb.a070808. [DOI] [PubMed] [Google Scholar]
  4. Devane J., Ryan M. P. The effects of amiloride and triamterene on urinary magnesium excretion in conscious saline-loaded rats. Br J Pharmacol. 1981 Feb;72(2):285–289. doi: 10.1111/j.1476-5381.1981.tb09127.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Duarte C. G. Effects of ethacrynic acid and furosemide on urinary calcium, phosphate and magnesium. Metabolism. 1968 Oct;17(10):867–876. doi: 10.1016/0026-0495(68)90151-0. [DOI] [PubMed] [Google Scholar]
  6. Duke M. Thiazide-induced hypokalemia. Association with acute myocardial infarction and ventricular fibrillation. JAMA. 1978 Jan 2;239(1):43–45. doi: 10.1001/jama.239.1.43. [DOI] [PubMed] [Google Scholar]
  7. Dyckner T., Helmers C., Lundman T., Wester P. O. Initial serum potassium level in relation to early complications and prognosis in patients with acute myocardial infarction. Acta Med Scand. 1975 Mar;197(3):207–210. doi: 10.1111/j.0954-6820.1975.tb04903.x. [DOI] [PubMed] [Google Scholar]
  8. Dyckner T. Serum magnesium in acute myocardial infarction. Relation to arrhythmias. Acta Med Scand. 1980;207(1-2):59–66. doi: 10.1111/j.0954-6820.1980.tb09676.x. [DOI] [PubMed] [Google Scholar]
  9. HORTON R., BIGLIERI E. G. Effect of aldosterone on the metabolism of magnesium. J Clin Endocrinol Metab. 1962 Dec;22:1187–1192. doi: 10.1210/jcem-22-12-1187. [DOI] [PubMed] [Google Scholar]
  10. Hulting J. In-hospital ventricular fibrillation and its relation to serum potassium. Acta Med Scand Suppl. 1981;647:109–116. doi: 10.1111/j.0954-6820.1981.tb02646.x. [DOI] [PubMed] [Google Scholar]
  11. Hänze S., Seyberth H. Untersuchungen zur Wirkung der Diuretica Furosemid, Etacrynsäure und Triamteren auf die renale Magnesium- und Calciumaussecheidung. Klin Wochenschr. 1967 Mar 15;45(6):313–314. doi: 10.1007/BF01747104. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Lim P., Jacob E. Magnesium deficiency in patients on long-term diuretic therapy for heart failure. Br Med J. 1972 Sep 9;3(5827):620–622. doi: 10.1136/bmj.3.5827.620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Nordrehaug J. E. Malignant arrhythmias in relation to serum potassium values in patients with an acute myocardial infarction. Acta Med Scand Suppl. 1981;647:101–107. doi: 10.1111/j.0954-6820.1981.tb02645.x. [DOI] [PubMed] [Google Scholar]
  15. Seller R. H., Cangiano J., Kim K. E., Mendelssohn S., Brest A. N., Swartz C. Digitalis toxicity and hypomagnesemia. Am Heart J. 1970 Jan;79(1):57–68. doi: 10.1016/0002-8703(70)90394-7. [DOI] [PubMed] [Google Scholar]
  16. Seller R. H. The role of magnesium in digitalis toxicity. Am Heart J. 1971 Oct;82(4):551–556. doi: 10.1016/0002-8703(71)90242-0. [DOI] [PubMed] [Google Scholar]
  17. Wheeler P. G., Smith T., Golindano C., Alam A. N., Wilkinson S. P., Edmonds C. J., Williams R. Potassium and magnesium depletion in patients with cirrhosis on maintenance diuretic regimens. Gut. 1977 Sep;18(9):683–687. doi: 10.1136/gut.18.9.683. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES