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Moran JL, Gallagher J, Peake SL, Cunningham DN, Salagaras M, Leppard P. Parenteral magnesium sulfate versus amiodarone in the therapy of atrial tachyarrhythmias: a prospective, randomized study. Crit Care Med 1995; 23:1816-24. [PMID: 7587256 DOI: 10.1097/00003246-199511000-00005] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the efficacy of parenteral magnesium sulfate vs. amiodarone in the therapy of atrial tachyarrhythmias in critically ill patients. DESIGN Prospective, randomized study. SETTING Multidisciplinary intensive care unit (ICU) at a university teaching hospital. PATIENTS Forty-two patients, 21 medical and 21 surgical, of mean (SD) age 67 +/- 15 yrs and mean Acute Physiology and Chronic Health Evaluation II score of 22 +/- 6, with atrial tachyarrhythmias (ventricular response rate of > or = 120 beats/min) sustained for > or = 1 hr. INTERVENTIONS After correction of the plasma potassium concentration to > or = 4.0 mmol/L, patients were randomly allocated to treatment with either a) magnesium sulfate 0.037 g/kg (37 mg/kg) bolus followed by 0.025 g/kg/hr (25 mg/kg/hr); or b) amiodarone 5 mg/kg bolus and 10 mg/kg/24-hr infusion. Therapeutic plasma magnesium concentration in the magnesium sulfate group was 1.4 to 2.0 mmol/L. Therapeutic end point was conversion to sinus rhythm over 24 hrs. MEASUREMENTS AND MAIN RESULTS At study entry (time 0), initial mean ventricular response rate and systolic blood pressure were 151 +/- 16 (SD) beats/min and 127 +/- 30 mm Hg in the magnesium sulfate group vs. 153 +/- 23 beats/min and 123 +/- 23 mm Hg in the amiodarone group, respectively (p = .8 and .65). Plasma magnesium (time 0) was 0.84 +/- 0.20 vs. 1.02 +/- 0.22 mmol/L in the magnesium and amiodarone group, respectively (p = .1). Eight patients had chronic dysrhythmias (magnesium 3, amiodarone 5). Excluding the two patient deaths (amiodarone group, time 0 + 12 to 24 hrs), no significant change in systolic blood pressure subsequently occurred in either group. In the magnesium group, mean plasma magnesium concentrations were 1.48 +/- 0.36, 1.82 +/- 0.41, 2.16 +/- 0.45, and 1.92 +/- 0.49 mmol/L at time 0 + 1, 4, 12 and 24 hrs, respectively. By logistic regression, the probability of conversion to sinus rhythm was significantly better for magnesium than for amiodarone at time 0 + 4 (0.6 vs. 0.44), 12 (0.72 vs. 0.5), and 24 (0.78 vs. 0.5) hrs. In patients not converting to sinus rhythm, a significant decrease in ventricular response rate occurred at time 0 + to 0.5 hrs (mean decrease 19 beats/min, p = .0001), but there was no specific treatment effect between the magnesium and the amiodarone groups; thereafter, there was no significant reduction in ventricular response rate over time in either group. CONCLUSIONS Intravenous magnesium sulfate is superior to amiodarone in the conversion of acute atrial tachyarrhythmias, while initial slowing of ventricular response rate in nonconverters appears equally efficacious with both agents.
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Affiliation(s)
- J L Moran
- Queen Elizabeth Hospital, Woodville, South Australia
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54
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Muir KW, Lees KR. A randomized, double-blind, placebo-controlled pilot trial of intravenous magnesium sulfate in acute stroke. Stroke 1995; 26:1183-8. [PMID: 7541572 DOI: 10.1161/01.str.26.7.1183] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Magnesium ions act as endogenous vasodilators of the cerebral circulation and act pharmacologically as noncompetitive antagonists of the N-methyl-D-aspartate receptor by virtue of their role as endogenous voltage-sensitive blockers of the ion channel. The preclinical efficacy of magnesium has been demonstrated in standard models of stroke. METHODS Sixty patients were randomized to magnesium sulfate (8 mmol IV over 15 minutes and 65 mmol over 24 hours) or placebo within 12 hours of clinically diagnosed middle cerebral artery stroke. Pulse, blood pressure, and serum magnesium levels were monitored. Primary outcome was death or significant functional impairment (Barthel Index score < 60) at 3 months. RESULTS Magnesium was well tolerated, with no significant adverse effects and no change in blood pressure or pulse rate. Laboratory and electrocardiographic variables did not differ significantly between placebo- and magnesium-treated groups. Serum magnesium rose from 0.76 mmol/L to 1.42 mmol/L over 24 hours and remained significantly higher than in the placebo group at 48 hours. Thirty percent of magnesium-treated and 40% of placebo-treated patients were dead or disabled (Barthel Index score < 60) at 3 months (P = .42). There was a decrease in the number of early deaths in the magnesium-treated group (P = .066, log-rank test). CONCLUSIONS Magnesium sulfate is well tolerated after acute stroke and has no deleterious hemodynamic effects at this dose. Further trials are required to determine efficacy.
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Affiliation(s)
- K W Muir
- University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland
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55
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Delhumeau A, Granry JC, Monrigal JP, Costerousse F. [Indications for the use of magnesium in anesthesia and intensive care]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1995; 14:406-16. [PMID: 8572407 DOI: 10.1016/s0750-7658(05)80393-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Magnesium (Mg), a cofactor in numerous enzymatic reactions, is often ignored by clinicians, as the symptomatology of Mg depletion is not specific and usually associated with that of the cause of the depletion. Furthermore, the plasma Mg concentration (0.8 to 1.1 mmol.L-1) is only equivalent to one percent of the total body content. A Mg deficit may exist while plasma Mg concentration is normal. Therefore other techniques for Mg assessment, such as the repletion test, as well as red blood cell and lymphocyte concentrations have been used. A renewed interest for Mg occurred as numerous studies have shown the therapeutic efficiency of Mg and as the mechanisms of its haemodynamic effects have been recognized. Mg regulates Na-K-ATPase activity, K channels activity and, most of all, it is a natural calcium channel blocking agent. These properties explain its important place in electrophysiology of myocardial cells and the effects on the tension of smooth muscles, resulting in a vasodilation and a bronchodilation respectively. The antagonistic effect of Mg on calcium decreases the presynaptic release of acetylcholine at the neuromuscular junction and the release of epinephrine at the peripheral sympathetic nerves and the adrenals. Mg potentiates the effect of non-depolarizing muscle relaxants. A Mg deficiency occurs often in ICU patients, in alcoholics and during use of diuretics. Simultaneous administration of Mg is often required for treatment of potassium deficiency. Mg has an anti-arrhythmic effect towards digoxin-mediated dysrhythmias and torsades de pointes, and can be efficient in other arrhythmias. Systematic use of Mg seems to decrease mortality of acute myocardial infarction and is justified during cardiac surgery, often associated with hypomagnesemia, because of vasodilation of coronary arteries and in order to prevent occurrence of arrhythmias. Mg, because of its calcium channel blocking properties and as it lowers the release of epinephrine, is indicated for surgery of pheochromocytoma. In eclamptic and pre-eclamptic patients, the use of Mg is valuable, but not as an anti-epileptic agent. Other clinical uses of Mg have been proposed, but they are either anecdotal or of uncertain efficiency.
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Affiliation(s)
- A Delhumeau
- Département d'Anesthésie-Réanimation, CHU, Angers
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56
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Baty CJ, Sweet DC, Keene BW. Torsades de pointes-like polymorphic ventricular tachycardia in a dog. Vet Med (Auckl) 1994; 8:439-42. [PMID: 7884731 DOI: 10.1111/j.1939-1676.1994.tb03264.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C J Baty
- Department of Companion Animals and Special Species, North Carolina State University, College of Veterinary Medicine, Raleigh 27606
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57
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McCord J, Borzak S. Magnesium for myocardial infarction? HOSPITAL PRACTICE (OFFICE ED.) 1994; 29:47-57. [PMID: 8056858 DOI: 10.1080/21548331.1994.11443060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
There are several theoretical mechanisms by which magnesium might be beneficial against ischemic heart disease. Yet numerous studies of its use in acute MI show inconsistent results.
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Affiliation(s)
- J McCord
- Coronary Care Unit, Henry Ford Heart and Vascular Institute, Detroit
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58
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Skorodin MS, Freebeck PC, Yetter B, Nelson JE, Van de Graaff WB, Walsh JM. Magnesium sulfate potentiates several cardiovascular and metabolic actions of terbutaline. Chest 1994; 105:701-5. [PMID: 8131528 DOI: 10.1378/chest.105.3.701] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
beta-Adrenergic agonists are useful for the emergency treatment of asthma. Recently, magnesium sulfate (MgSO4) has also been shown to be efficacious in this situation. beta-Agonists have unwanted cardiovascular and metabolic actions: increased systolic blood pressure, corrected QT interval (QTc), serum glucose and insulin, and decreased RR interval, diastolic blood pressure, serum potassium, phosphate, and calcium. As beta-agonists and MgSO4 quite possibly will be used in combination, we sought to determine how MgSO4 would affect these actions. Healthy young male adults were administered two doses of terbutaline sulfate, 0.25 mg subcutaneously, 30 min apart on two separate occasions, in a randomized, double-blind fashion. On one occasion, 4 g of MgSO4 was administered intravenously over the same 30-min period. On the other, normal saline solution was given as a placebo. Cardiovascular and metabolic variables were measured sequentially for 2 h. Data at 60 min with p values given for a summation of all time points are as follows: MgSO4 increased terbutaline's effects on the RR interval by 0.09 s, p < 0.0001; QTc interval by 0.01 s, p < 0.0007; diastolic blood pressure by 8 mm Hg, p = 0.0001; serum calcium by 0.13 mg/dl, p = 0.01; and glucose by 9 mg/dl, p < 0.0001. MgSO4 also mitigated the systolic blood pressure elevating the effect of terbutaline by 5 mm Hg (p = 0.007). The magnitude of the response potentiations was modest. We conclude that combining terbutaline and MgSO4 is unlikely to result in serious short-term adverse events, if used acutely in patients with relatively normal cardiac and metabolic function. MgSO4 may act by potentiating the effect of beta-agonists on magnesium requiring enzymes such as adenyl cyclase.
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Affiliation(s)
- M S Skorodin
- Department of Veterans Affairs, Edward Hines Jr Hospital, Hines, Ill
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59
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Abstract
Magnesium has been reported as an effective medical therapy in an expanding array of conditions. Evidence investigating magnesium's use is presented, with a number of studies suggesting it should be seriously considered in such conditions as ischemic heart disease, cardiac arrhythmias, and asthma. Magnesium balance and metabolism are briefly reviewed, and then various hypotheses are presented that may explain magnesium's physiologic mechanisms of action, most likely involving calcium and potassium flux across cellular membranes in smooth muscle. In a number of the conditions to be discussed, it has been uncertain whether magnesium administration serves the purpose of merely correcting an underlying deficiency state or of utilizing a specific pharmacologic effect of magnesium. Magnesium deficiency is a relatively common condition, and predisposing factors as well as recent methods for assessing total body stores of magnesium are discussed. Physicians should be familiar with the numerous conditions and therapeutics that are risk factors for an underlying magnesium deficiency and in which empiric magnesium replacement should be considered. Guidelines for administration of parenteral magnesium are presented with specific focus on the low risk of adverse effects, as suggested by the large and rapid dosing regimens used in many of the clinical studies discussed here.
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Affiliation(s)
- R M McLean
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut 06510
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60
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Fazekas T, Scherlag BJ, Vos M, Wellens HJ, Lazzara R. Magnesium and the heart: antiarrhythmic therapy with magnesium. Clin Cardiol 1993; 16:768-74. [PMID: 8269653 DOI: 10.1002/clc.4960161105] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Magnesium is an essential transmembrane and intracellular modulator of the electrical activity of cardiac cells. This review provides an up-to-date consideration of the cellular and clinical electrophysiological role of magnesium. This ubiquitous element seems to be important from both the theoretical and clinical point of view, because magnesium salts (MgSO4, MgCl2) administered intravenously are particularly effective in those arrhythmias in which the mechanism involves early or delayed after depolarization-induced triggered activity. The authors share the view that I.V. magnesium is the drug of choice in "torsade de pointes" ventricular tachycardia accompanying acquired long QT/QTU syndrome. It is complementary therapeutic agent in digitalis-induced tachycardias. Further studies are needed to elucidate magnesium's mode of action and efficacy in other types of clinical tachyarrhythmias.
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Affiliation(s)
- T Fazekas
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190
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61
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Reinhart RA. Polymorphous ventricular tachycardia early after acute myocardial infarction. Am J Cardiol 1993; 72:863-4. [PMID: 8213538 DOI: 10.1016/0002-9149(93)91093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
1. Controlled trials, of which there are few, do not substantiate claims that diuretics play a role in causing magnesium deficiency. Consequently, the vast majority of patients taking conventional doses of thiazide diuretics (i.e. bendrofluazide 2.5 mg day-1 or equivalent) do not need magnesium supplements. On balance, potassium-sparing diuretics tend to increase serum and intracellular magnesium content; this should not be taken as evidence of prior magnesium deficiency. It remains theoretically possible that large doses of loop diuretics given more than once daily for long periods could induce negative magnesium balance and magnesium deficiency. However, it has been difficult to run appropriately controlled trials in conditions where such therapy is needed (i.e. heart failure) and until more reliable information becomes available no absolute recommendation can be made. 2. Methods for the measurement of intracellular free magnesium levels are now available and are more relevant to the assessment of magnesium deficiency than total intracellular magnesium content; the complex relationship between intracellular free and total magnesium content remains to be defined. Future work involving the effect of diuretics on intracellular free magnesium measurements should make every attempt to avoid the errors of trial design and multiple publication that litter current and past literature.
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Affiliation(s)
- D L Davies
- Department of Medicine and Therapeutics, Western Infirmary, Glasgow
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Nadler JL, Buchanan T, Natarajan R, Antonipillai I, Bergman R, Rude R. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertension 1993; 21:1024-9. [PMID: 8505087 DOI: 10.1161/01.hyp.21.6.1024] [Citation(s) in RCA: 157] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evidence suggests that magnesium deficiency may play an important role in cardiovascular disease. In this study, we evaluated the effects of a magnesium infusion and dietary-induced isolated magnesium deficiency on the production of thromboxane and on angiotensin II-mediated aldosterone synthesis in normal human subjects. Because insulin resistance may be associated with altered blood pressure, we also measured insulin sensitivity using an intravenous glucose tolerance test with minimal model analysis in six subjects. The magnesium infusion reduced urinary thromboxane concentration and angiotensin II-induced plasma aldosterone levels. The low magnesium diet reduced both serum magnesium and intracellular free magnesium in red blood cells as determined by nuclear magnetic resonance (186 +/- 10 [SEM] to 127 +/- 9 mM, p < 0.01). Urinary thromboxane concentration measured by radioimmunoassay increased after magnesium deficiency. Similarly, angiotensin II-induced plasma aldosterone concentration increased after magnesium deficiency. Analysis showed that all subjects studied had a decrease in insulin sensitivity after magnesium deficiency (3.69 +/- 0.6 to 2.75 +/- 0.5 min-1 per microunit per milliliter x 10(-4), p < 0.03). We conclude that dietary-induced magnesium deficiency 1) increases thromboxane urinary concentration and 2) enhances angiotensin-induced aldosterone synthesis. These effects are associated with a decrease in insulin action, suggesting that magnesium deficiency may be a common factor associated with insulin resistance and vascular disease.
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Affiliation(s)
- J L Nadler
- Department of Diabetes and Endocrinology, City of Hope Medical Center, Duarte, Calif. 91010
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Zhu Z, Kimura M, Itokawa Y. Selenium concentration and glutathione peroxidase activity in selenium and magnesium deficient rats. Biol Trace Elem Res 1993; 37:209-17. [PMID: 7688534 DOI: 10.1007/bf02783796] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To clarify the effects of selenium (Se) and magnesium (Mg) deficiencies on Se and glutathione peroxidase (GSHPx) status, weanling male Wistar rats weighing 50-60 g were placed on four kinds of diets divided by two levels of Se (0.5 or 0.019 mg/kg) and Mg (500 or 50 mg/kg) for 8 wk. Magnesium deficiency had an influence on distribution of Se, which was increased in muscle and decreased in other tissues. The changes in GSHPx matched those in Se. The levels of Se and GSHPx in most tissues were lower in Se-Mg-deficient rats than in Se-deficient rats. Thus, selenium and Mg deficiencies would make oxidant lesion more serious than Se deficiency.
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Affiliation(s)
- Z Zhu
- Department of Hygiene, Faculty of Medicine, Kyoto University, Japan
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65
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Dørup I, Skajaa K, Thybo NK. Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium-potassium pumps in skeletal muscle of patients receiving diuretic treatment. J Intern Med 1993; 233:117-23. [PMID: 8381850 DOI: 10.1111/j.1365-2796.1993.tb00663.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In 76 consecutive patients who had received diuretics for 1-17 years for arterial hypertension or congestive heart failure, muscle concentrations of magnesium, potassium, and sodium-potassium pumps were significantly reduced compared to 31 age- and sex-matched controls. Thirty-six patients with muscle magnesium and/or potassium below the control level received oral magnesium hydroxide supplement for 2-12 weeks (n = 20) or 26 weeks (n = 16). After short-term (2-12 weeks) magnesium supplementation muscle parameters were increased, but far from normalized. After magnesium supplementation for 26 weeks, the muscle concentrations of magnesium, potassium and sodium-potassium pumps were normalized in most cases. Oral magnesium supplementation may restore diuretic-induced disturbances in the concentrations of magnesium, potassium and sodium potassium pumps in skeletal muscle. A supplemental period of at least 6 months seems to be required before complete normalization can be expected.
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Affiliation(s)
- I Dørup
- Institute of Physiology, University of Aarhus, Denmark
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66
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Gurfinkel E, Pazos AA, Mautner B. Abnormal QT intervals associated with negative T waves induced by antiarrhythmic drugs are rapidly reduced using magnesium sulfate as an antidote. Clin Cardiol 1993; 16:35-8. [PMID: 8416758 DOI: 10.1002/clc.4960160108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This study was undertaken to determine whether prolonged QTc interval as a consequence of abnormal repolarization induced by coronary disease or antiarrhythmic drugs could be shortened by intravenous administration of magnesium sulfate. A total of 21 patients with basal prolonged QTc intervals (QTc > 500 ms) were divided in two groups: 7 with ischemic coronary disease and negative T waves (Group A), and 14 treated with antiarrhythmic drugs (Group B). Nine of the latter had negative T waves (Subgroup B-1) and five had positive T waves (Subgroup B-2) recorded in precordial leads. Nine patients were taking amiodarone and six quinidine. Magnesium sulfate was given intravenously in a bolus of 3.75 g (25% solution) over 3 min. Patients had normal electrolyte serum levels. The prolonged QTc and JTc intervals were shortened after magnesium sulfate in patients of Subgroup B-1 from the basal values [QTc 20.7% and JTc 25.4%, (p = < 0.0001 and 0.02, respectively)]. None of the patients in Group A or Subgroup B-2 experienced altered QTc or JTc intervals. While some antiarrhythmic drugs are capable of altering the refractoriness of ventricular cells, probably by causing changes in the intracellular metabolic pathways, in patients with coronary disease gaps in the membrane induced by ischemic injury let calcium enter the cells parallel with dispersion of ventricular repolarization. When secondary negative T waves are present, magnesium sulfate as an antidote probably acts as a blocking agent at the sarcoplasmic reticulum, thus reducing both QTc and JTc intervals.
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Affiliation(s)
- E Gurfinkel
- Emergency Department, Fernández Hospital, Buenos Aires, Argentina
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Affiliation(s)
- M A Arsenian
- Department of Internal Medicine, Cape Ann Medical Center, Gloucester, MA 01930
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68
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Abstract
It is well established that clinically significant changes in a number of electrolytes occur in patients with congestive heart failure (CHF). Magnesium ions are an essential requirement for many enzyme systems, and evidence is rapidly emerging that magnesium deficiency is a major risk factor for survival of CHF patients. In animal experiments, magnesium has been shown to be involved in several steps of the atherosclerotic process and, although in humans the situation is somewhat more complex, magnesium ions play an extremely important role in CHF and various cardiac arrhythmias. A number of drugs commonly used to treat CHF can significantly affect not only cellular magnesium ion homeostasis, but potassium as well. These include mercurial, thiazide, and loop diuretics. It has also been reported that hypomagnesemia is common in digitalis intoxication. In contrast, a number of agents have been shown to have either a magnesium-conserving effect (potassium-sparing diuretics) or not to affect magnesium ion balance (angiotensin-converting enzyme inhibitors). The clinical consequences of magnesium deficiency include the development of various cardiac arrhythmias, all of which respond well to magnesium treatment. Thus, it is more than apparent that magnesium ion homeostasis is of major importance in CHF. Future studies should address the complex role of magnesium ions in electrolyte imbalance, particularly in relation to heart failure.
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Affiliation(s)
- P O Wester
- Department of Medicine, Umeå University Hospital, Sweden
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Reinhart RA. Magnesium deficiency: recognition and treatment in the emergency medicine setting. Am J Emerg Med 1992; 10:78-83. [PMID: 1736922 DOI: 10.1016/0735-6757(92)90133-i] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Magnesium deficiency and its clinical manifestations are common in patients presenting to the emergency department. Assessment of the total body magnesium status of a patient is problematic since the serum magnesium concentration, the only readily available clinical test for this condition, may not be accurate in predicting the intracellular magnesium concentration. Therefore, empiric magnesium therapy should be considered in high-risk patients. Since magnesium participates in numerous metabolic processes in the body, a deficiency can affect multiple organ systems and present clinically in a variety of ways. Magnesium deficiency is reviewed in this paper with regard to therapeutic implications; specific treatment guidelines are given including dose, infusion rate, and magnesium preparation. Magnesium is also reviewed with regard to its homeostasis and metabolic role in the body. Special mention is made regarding precautions for use of magnesium in the setting of renal insufficiency.
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Affiliation(s)
- R A Reinhart
- Department of Cardiology, Marshfield Clinic, WI 54449
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