Subcutaneous magnesium in the advanced cancer setting

Possibility of magnesium supplementation for supportive treatment in patients with COVID-19

Magnesium as an enzymatic activator is essential for various physiological functions such as cell cycle, metabolic regulation, muscle contraction, and vasomotor tone. A growing body of evidence supports that magnesium supplementation (mainly magnesium sulfate and magnesium oxide) prevents or treats various types of disorders or diseases related to respiratory system, reproductive system, nervous system, digestive system, and cardiovascular system as well as kidney injury, diabetes and cancer. The ongoing pandemic coronavirus disease 19 (COVID-19) characterized by respiratory tract symptoms with different degrees of important organ and tissue damages has attracted global attention. Particularly, effective drugs are still lacking in the COVID-19 therapy. In this review, we find and summarize the effectiveness of magnesium supplementation on the disorders or diseases, and provide a reference to the possibility of magnesium supplementation for supportive treatment in patients with COVID-19.

Magnesium: The overlooked electrolyte in blood cancers?

Magnesium is an important element that has essential roles in the regulation of cell growth, division, and differentiation. Mounting evidence in the literature suggests an association between hypomagnesemia and all-cause mortality. In addition, epidemiologic studies have demonstrated that a diet poor in magnesium increases the risk of developing cancer, highlighting its importance in the field of hematology and oncology. In solid malignancies, hypomagnesemia at diagnosis portends a worse prognosis. However, little is known about prognosis in patients with hypomagnesemia and blood cancers in general; lymphoma more specifically. Hypomagnesemia has been associated with a higher viral load of the Epstein Barr virus, a virus associated with a multitude of hematologic malignancies. The role of magnesium in the immune system has been further elucidated in studies of patients with a rare primary immunodeficiency known as XMEN disease (X-linked immunodeficiency with Magnesium defect, Epstein-Barr virus (EBV) infection, and Neoplasia disease). These patients have a mutation in the MAGT1 gene, which codes for a magnesium transporter. The mutation leads to impaired T cell activation and an increased risk of developing hematologic malignancies. In this review we discuss the relevance of magnesium as an electrolyte, current measurement techniques, and the known data related to cause and prognosis of blood cancers. The goal is to use these data to stimulate additional high-quality and well powered studies to further investigate the role of magnesium in preventing cancer and improving outcomes of patients with malignancy and concomitant magnesium deficiency.

Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia

Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn's disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfatewas effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia.