Assuntos
Humanos , Masculino , Feminino , Idoso , Inibidores da Bomba de Prótons/efeitos adversos , Deficiência de Magnésio/induzido quimicamente , Estudos de Casos e Controles , Prevalência , Estudos Transversais , Fatores de Risco , Corticosteroides/uso terapêutico , Insuficiência Renal Crônica/complicações , Inibidores de Calcineurina/uso terapêutico , Magnésio/uso terapêutico , Deficiência de Magnésio/sangueRESUMO
Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain. In the present study, the modulatory effects of N-methyl-d-aspartate receptors (NMDA-Rs) and magnesium were investigated in TMJ arthritis hypernociception. Male Wistar rats received an intra-articular injection of carrageenan (Cg) in the TMJ, and mechanical hypernociception was measured. The NMDA-R antagonist, MK-801, and magnesium chloride (MgCl2 ) were administered before arthritis induction. Magnesium deficiency was promoted by feeding rats a synthetic magnesium-free diet for 9 d before injection of Cg. The Cg induced mechanical hypernociception that lasted for 120 h. MK-801 inhibited this hypernociceptive state. MgCl2 pretreatment prevented Cg-induced hypernociception and altered the nociceptive threshold in the absence of Cg. Magnesium deficiency increased hypernociception and induced spontaneous hypernociceptive behavior. TMJ arthritis increased the expression of mRNA for all NMDA-R subunits and immunostaining of phosphorylated NR1 (phospho-NR1). MgCl2 inhibited expression of NR2B mRNA and phospho-NR1 immunostaining and increased expression of NR3 mRNA. Magnesium deficiency increased expression of both NR1 and NR3 mRNAs and phospho-NR1 immunostaining in the trigeminal subnucleus caudalis. We found that magnesium modulates nociceptive behavior and induces NMDA-R subunit rearrangement in the subnucleus caudalis. The present results may lead to a better understanding of central processing in the nociceptive trigeminal pathway and the development of new approaches to treat orofacial pain with a TMJ origin.
Assuntos
Deficiência de Magnésio/metabolismo , Magnésio/farmacologia , Osteoartrite/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Transtornos da Articulação Temporomandibular/metabolismo , Núcleo Inferior Caudal do Nervo Trigêmeo/metabolismo , Nervo Trigêmeo/efeitos dos fármacos , Análise de Variância , Animais , Carragenina , Expressão Gênica , Magnésio/sangue , Deficiência de Magnésio/induzido quimicamente , Masculino , Dados de Sequência Molecular , Dor Nociceptiva/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transtornos da Articulação Temporomandibular/induzido quimicamente , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Fatores de Tempo , Nervo Trigêmeo/metabolismoRESUMO
OBJECTIVE: The aim of this study was to evaluate the association of serum magnesium levels with proton pump inhibitors (PPIs) use and other factors. METHODS: This was a cross-sectional study of 151 patients admitted with acute diseases in the Internal Medicine Division of the Hospital de Clinicas de Porto Alegre, after the exclusion of conditions that are commonly associated with hypomagnesemia: diarrhea; vomiting; chronic alcohol use; severely uncompensated diabetes mellitus; and chronic use of laxatives, diuretics or other drugs causing magnesium deficiency. RESULTS: All patients had normal serum magnesium levels. Serum albumin and creatinine levels were positively associated with serum magnesium levels, after adjusting for confounders. There was no difference between mean serum magnesium levels of PPI users and non-users, nor between men and women; there was also no correlation among age, serum phosphorus, and potassium levels with serum magnesium levels. Limitations of this study include the absence of an instrument for measuring adherence to PPI use and the sample size. CONCLUSION: The association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.
OBJETIVO: O objetivo desse estudo foi verificar a associação do nível sérico do magnésio com o uso de inibidores de bomba de prótons (IBP) e outros fatores. MÉTODOS: Realizou-se estudo transversal com 151 pacientes admitidos com doenças agudas no serviço de medicina interna do Hospital de Clínicas de Porto Alegre. Foram excluídos aqueles pacientes com condições usualmente relacionadas à hipomagnesemia: diarréia; vômitos; diabéticos agudamente descompensados; uso crônico de laxantes, álcool, diuréticos ou outros fármacos relacionados. RESULTADOS: Todos os pacientes apresentaram níveis normais de magnésio. Albumina e creatinina sérica se associaram positivamente com os níveis de magnésio sérico, após ajuste para fatores confundidores. Não houve diferença no nível sérico de magnésio em usuários ou não-usuários de IBP ou entre homens e mulheres. Não houve correlação com idade, nível sérico de fósforo e potássio. As principais limitações desse estudo foram a ausência de instrumento para medir a adesão aos IBPs e o tamanho da amostra. CONCLUSÃO: A associação do uso de IBP e hipomagnesemia é rara. Defeitos congênitos no metabolismo do magnésio devem ser responsáveis pelo surgimento de hipomagnesemia em usuários de dessa classe de fármacos.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Deficiência de Magnésio/induzido quimicamente , Deficiência de Magnésio/epidemiologia , Magnésio/sangue , Inibidores da Bomba de Prótons/efeitos adversos , Creatinina/sangue , Métodos Epidemiológicos , Deficiência de Magnésio/sangue , Deficiência de Magnésio/diagnóstico , Albumina Sérica/análiseRESUMO
OBJECTIVE: The aim of this study was to evaluate the association of serum magnesium levels with proton pump inhibitors (PPIs) use and other factors. METHODS: This was a cross-sectional study of 151 patients admitted with acute diseases in the Internal Medicine Division of the Hospital de Clinicas de Porto Alegre, after the exclusion of conditions that are commonly associated with hypomagnesemia: diarrhea; vomiting; chronic alcohol use; severely uncompensated diabetes mellitus; and chronic use of laxatives, diuretics or other drugs causing magnesium deficiency. RESULTS: All patients had normal serum magnesium levels. Serum albumin and creatinine levels were positively associated with serum magnesium levels, after adjusting for confounders. There was no difference between mean serum magnesium levels of PPI users and non-users, nor between men and women; there was also no correlation among age, serum phosphorus, and potassium levels with serum magnesium levels. Limitations of this study include the absence of an instrument for measuring adherence to PPI use and the sample size. CONCLUSION: The association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.
Assuntos
Deficiência de Magnésio/induzido quimicamente , Deficiência de Magnésio/epidemiologia , Magnésio/sangue , Inibidores da Bomba de Prótons/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Métodos Epidemiológicos , Feminino , Humanos , Deficiência de Magnésio/sangue , Deficiência de Magnésio/diagnóstico , Masculino , Pessoa de Meia-Idade , Albumina Sérica/análise , Adulto JovemRESUMO
Magnesium homeostasis is essential for many intracellular processes and depends on dynamic interplay of intestinal absorption, exchange with the bone reservoir, and renal excretion. Hypomagnesaemia may arise from various disorders. We review the case of a 59 year-old man whose only complaint was irritability with a routine analysis showing hypomagnesaemia and hypokalemia while using esomeprazole, a proton pump inhibitor (PPI). Fractional magnesium excretion was low, excluding excessive renal loss. Potassium excretion was 80 mEq/24 Hr in the presence of hypokalemia suggesting hypomagnesaemia-induced kaliuresis as its cause. Hypomagnesaemia partially resolved after oral magnesium supplementation. Esomeprazol suppression corrected hypomagnesaemia. A causal relationship with esomeprazol use was supported by the recurrence of hypomagnesaemia after rechallenge. We review the literature on hypomagnesaemia due to the use of proton pump inhibitors. In the past decade our understanding of transcellular magnesium transport was enhanced by the discovery of the magnesium channel, transient receptor potential (TR PM) 6 and 7 and other proteins that play an important role in its transport. In this light we discuss the possible etiology of proton pump inhibitor related hypomagnesaemia/hypokalemia.
Assuntos
Esomeprazol/efeitos adversos , Hipopotassemia/induzido quimicamente , Magnésio/sangue , Inibidores da Bomba de Prótons/efeitos adversos , Antiulcerosos/efeitos adversos , Antiulcerosos/uso terapêutico , Esomeprazol/uso terapêutico , Humanos , Magnésio/metabolismo , Deficiência de Magnésio/induzido quimicamente , Masculino , Pessoa de Meia-IdadeRESUMO
Severe magnesium deficiency associated with proton pump inhibitors (PPIs) has been described recently with clinical presentations varying from life-threatening conditions to muscle cramps and paresthesias. Probably milder cases go undetected. We report an asymptomatic case of hypomagnesemia associated with chronic use of PPIs in a 67-year-old woman. She had had symptoms of gastroesophageal reflux disease for several years, which abated partially with PPIs, and denied any other symptoms or medications. Her initial evaluation showed an unexplained hypomagnesemia with a very low magnesium excretion rate in urine. Serum calcium, phosphorus, potassium, and glucose levels and renal function were normal. After PPI withdrawal, serum and urinary magnesium levels normalized.
Assuntos
Monitoramento de Medicamentos , Deficiência de Magnésio/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Feminino , HumanosRESUMO
OBJECTIVE: To obtain quantitative serum levels of total and ionized magnesium (Mg(2+)) in children with homozygous sickle cell anemia (SCA) undergoing therapy with hydroxyurea. STUDY DESIGN: Five children, ages 11 to 14 years with homozygous SCA, were enrolled in a dose-escalating trial of hydroxyurea over an 18-month period. Serum levels of total and ionized magnesium together with ionized K(+), Na(+), and Ca(2+) were measured before hydroxyurea and every 6 months during hydroxyurea therapy. RESULTS: Before treatment, 4 of the 5 patients had low or below-normal serum concentrations of Mg(2+) (normal range, 0.51-0.67 mmol/L). All 5 became Mg(2+)-deficient during hydroxyurea therapy, with no indication of recovery until after 12 to 18 months of drug administration (P <.05). Similar changes were noted for total magnesium concentrations. Mean serum levels of K(+), Na(+), and Ca(2+) remained consistently within normal ranges. CONCLUSIONS: These findings warrant a controlled study of the effects of magnesium supplementation in patients with SCA receiving hydroxyurea. Potentially, such therapy could alleviate or prevent vaso-occlusive crises.
Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/efeitos adversos , Hidroxiureia/efeitos adversos , Deficiência de Magnésio/induzido quimicamente , Adolescente , Análise de Variância , Antidrepanocíticos/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Feminino , Humanos , Hidroxiureia/administração & dosagem , Masculino , Projetos Piloto , Fatores de TempoRESUMO
Antecedentes. El magnesio participa en numerosas reacciones enzimáticas vitales para el organismo. Objetivo. Identificar la prevalencia de hipomagnesemia (Mg < 1.6 mg/dl), sus características clínicas y su relación con el tratamiento diurético. Material y métodos. Se evaluaron 43 pacientes adultos con diagnóstico de insuficiencia cardiaca congestiva (ICC), clase funcional I-IV, sin daño renal, que recibieran el mismo tratamiento en las cuatro semanas previas al estudio. Se midieron las concentraciones de magnesio, sodio, potasio y calcio. Se registró el tratamiento diurético que estaba recibiendo cada paciente. Resultados. Tuvieron hipomagnesemia siete pacientes (16.2 por ciento) (Mg 1.5 ñ 0.07), los restantes 36 (83.8 por ciento) fueron normales (Mg 2.1 ñ 0.58). Las manifestaciones clínicas no fueron estadísticamente diferentes en ambos grupos. Las concentraciones de potasio y calcio fueron menores en el grupo de hipomagnesemia que en el de magnesio normal. Cuando se utilizó furosemida la concentración de magnesio fue menor en ambos grupos. Conclusiones. En pacientes con insuficiencia cardiaca congestiva la hipomagnesemia es un trastorno común que debería investigarse con más frecuencia por los clínicos debido al riesgo potencial de complicaciones del ritmo cardiaco
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diuréticos/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Deficiência de Magnésio/sangue , Deficiência de Magnésio/induzido quimicamente , Sinais e SintomasRESUMO
Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.
Assuntos
Gentamicinas/efeitos adversos , Deficiência de Magnésio/etiologia , Idoso , Alcalose/complicações , Alcalose/etiologia , Feminino , Humanos , Hipopotassemia/complicações , Hipopotassemia/etiologia , Hiponatremia/complicações , Hiponatremia/etiologia , Deficiência de Magnésio/induzido quimicamente , Deficiência de Magnésio/complicaçõesRESUMO
We studied the pathogenesis of cyclosporine-induced hypomagnesemia in five patients with nephrosis. Serum magnesium concentrations and urinary excretion of magnesium were reduced by the therapy. In contrast, the magnesium concentrations in mononuclear blood cells were increased. We conclude that short-term use of cyclosporine induces an intracellular shift of magnesium and causes hypomagnesemia.