,

www.bpath.gr
www.atherosclerosis.gr

 Mg2+
1.3-2.1 mEq/L
0.65-1.05 mmol/L
1.5-2.5 mg/dL
1 mmol Mg2+= 24 mg = 2 mEq

 Mg2+
Mg2+: 1.000 mmol (25 g) (50-60%
)
Mg2+: 1%
Mg2+: 300-350 mg
: 100 mg (5%
Mg2+)

 Mg2+
[,
] (30-50%),
, D

 Mg2+
80% Mg2+
Mg2+
(10-15%),
Henle (60-70%)
( 10%)

: Mg+2<1.3 mEq/L
(0.65 mmol/L, 1.5 mg/dL)


(/)
/


Mg2+ : ,
, , hungry bone syndrome
Mg2+:
-
-

(,

,
)
Gitelman

CISPLATIN

-TACROLIMUS
FOSCARNET

CETUXIMAB

Am J Kidney Dis 2010;56:168-74

ANTIEPIDERMAL GROWTH FACTOR

RECEPTOR-TARGETING DRUGS

[Cetuximab/Panitumumab]

FDA U.S. FOOD AND DRUG ADMINISTRATION

SAFETY
Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication
- Low Magnesium Levels Can Be Associated With Long-Term
Use
Prescription PPIs include Nexium (esomeprazole magnesium),
Dexilant (dexlansoprazole), Prilosec (omeprazole), Zegerid
(omeprazole and sodium bicarbonate), Prevacid (lansoprazole),
Protonix (pantoprazole sodium), AcipHex (rabeprazole sodium),
and Vimovo (a prescription combination drug product that
contains a PPI (esomeprazole magnesium and naproxen).
Over-the-counter
(OTC)
PPIs
include
Prilosec
OTC
(omeprazole),
Zegerid
OTC
(omeprazole
and
sodium
bicarbonate), and Prevacid 24HR (lansoprazole).

;
(30%):
[(
,

,
,
,

( , PO3-4)]

( 1/3 )

 30%

H. Milionis et al: Am J Hematol 1999;62: 201-207

H. Milionis et al: Eur J Haematol 2005;75: 449-460

30%

43-64%

+
Mg2+

Fillipatos et al: Eur J Hematol 2005;75:449-60

 Mg2+
()

(n=64)
1.60.1
mEq/L

1.70.1
mEq/L

p
0.05

R. Kalaitzidis et al: Am J Kidney Dis 2005;45: 851-858

( ):
Mg2+
Henle, Ca2+ / Mg2+
:
Mg2+
Mg2+

IV :

Ca2+
PTH PO43-

: Mg2+ (
, ), ;

Acute Pancreatitis-Induced Hypomagnesemia

G. Liamis et al: Pancreatology;2001;1: 74-76

 17.4%

H. Milionis et al: Eur J Heart Fail 2002;4: 167-173



Mg2+
Mg2+ (, )
Mg2+
Mg2+ ()

( +, PO43-,
)



Mg2+

Mg2+

(,

Mg2+
: [FEMg2+ 8% (>4%)]

De Marchi et al: N Engl J Med 1993;329: 1927-1934

M. Elisaf et al: J Trace Elements Med Biol 1995;9: 210-214

M. Elisaf et al: J Trace Elements Med Biol 1995;9: 210-214


(n=127)

12.6%

29.9%

17.3%

29.1%

20.5%
M. Elisaf et al: Miner Electrolyte Metab 1994;20: 274-281

N=107/2284, 4.7%

 15.2%

G. Liamis et al: Intern Med 2007;46: 685-90


+

/

GITELMAN

 GITELMAN
:

PRA, ALDO

Cisplatin
PPIs

: ,
Trousseau and Chvostek, , ,
, , , , ,
,
,
,
,

:
, ,

-
:
QRS, ,
P-Q, , U,
, ,
, torsade de pointes
:

:
( Mg2+ <1 mEq/L)
Y

 (<1 mEq/L)

PTH

PTH

PTH

 Mg2+


24h Mg2+
FEMg2+
Mg2+ 24h >20 mg
(30 mg)
FEMg2+ >4%

Mg2+ 24h <10 mg

FEMg2+ <4% (2%)

FE Mg2+ >4%

M. Elisaf et al: Magnesium Res 1997;10:315-320

 Mg2+ (FEMg2+)

1.4% (0.5-2.7%)

15% (4-48%)

M. Elisaf et al: Magnesium Research 1997;10: 315-320


1. Magnesium sulfate 7 2/DEMO, 25%
10 ml 10.2 mmol Mg2+
(20.4 mEq 247 mg)
10 ml
250 ml 0.9%
5% ( HCO3-),
2-3 h


2. TROFOCARD/UNI-PHARMA
Mono-magnesium L-aspartatehydrochloride trihydrate
614.8 mg 60.77 mg Mg2+ (5 mEq
Mg2+)
1229.6 mg 121.5
mg Mg2+ (10 mEq Mg2+)
(5 ml)
614.8 mg 60.8 mg Mg2+ (5 mEq
Mg2+)


TROFOCARD:
2 3/
1 3/ ( ,
)
: 4-5
(10-12.5 mmol Mg2+) 1L NaCl 0.9%
5%, 12h


3. Mag2/GALENICA
(pidolate de
magnesium)
10 mL (122 mg Mg2+,
10 mEq Mg2+)
3-4
/

4. TRIMAGNESIUM CITRATE AND MAGNESIUM

ASPARTATE DEHYDRATE [MAGNESIUM SANDOZ]

243
mg Mg2+ (10 mmol = 20 mEq)
1-2 /


1. :
X per os .. 2 ( 1
) Trofocard X 3/ (~30
mEq/) 3 Mag2/


2. : ( + + Ca2+)
IV 50 mEq 8-24h (.. 2 amp
MgSO4 1
HCO3-)
MgSO4
3-5
Mg2+
Mg2+ <2.5 mEq/L


3.

8-16 mEq Mg2+ 5-10

48-64 mEq 3-5

IV Mg2+

: Mg+2>2.1
mEq/L (1.05 mmol/L, 2.5 mg/dL)

 + Mg+2
(.. --)


1. NaCl 0.9%
Mg2+
2 g Ca2+/L
[150-200 ml/h]
2.
: IV Ca2+
(1-2 g 10),

3. :

: PO4-3<2.5 mg/dL

..

( Fanconi)

 FANCONI

Prominent

hypophosphatemia

due

to

proximal tubulopathy mimicking Fanconis

syndrome in a patient with obstructive
jaundice
G. Kalambokis et al: Clin Nephrol 2006;65:306-7

(,

[FEPO43-=35% (>20%] :
(
)

Elisaf M. et al; Int J Clin Pract 1997;51: 501-503


PCO2




Fanconi

..

[ FIBROLAST GROWTH FACTOR 23

PO43- + 1- 25 ()2
D3]

(
ADH)

50%

Legionnaires disease
Am J Med 2006;119: e5-e6

 D/W 5%
(
,
)

PO43

PO43- 24h <100 mg PO43- 24h >100 mg

FEPO43- <20% (<5%)

FEPO43- >20%


A) : tablets PHOSPHATE SANDOZ EFFERVESCENT
: 500 mg (16.1 mmol)
+ 315 mg KHCO3 (3.1 mEq K+)
+ 350 mg NaHCO3
+ 800 mg
+ = 20.4 mEq

:
: 6
: 4-6 (.. 1-2
3 )
PO43- >4.5 mg/dL
Ca2+ X PO43- >60
: , ,


) Glycophos
(Fresenius Cabi)
(20 ml) 1 mmol
phosphate/ml 2 mmol Na+/ml
.. 500 ml NaCl 0.45%
(/2) [ D/W]
6h.

1 mEq PO4-3 = 31 mg PO4-3


IV (
Ca2+)
0.2-0.8 mmol/Kg ( 500 ml /2) 6h P Ca2+
( 6h)
IV
PO4-3 >1.5 mg/dl
H IV 24-36 h

: PO4-3>4.5 mg/dL


gG ,
.Walderstrome)

. PO43-

PO43- (

: (,
, )
D

+
PO43
o
Ca2+

A tumor lysis-like syndrome during therapy

of visceral leishmaniasis
3

9.8 mg/dL ( 5.1 mg/dL)

5.9 mEq/L ( 4.1 mEq/L)

PO43-

5.2 mg/dL ( 3.1 mg/dL)

E. Liberopoulos et al: Ann Clin Lab Sci 2002;32:419-21


1.

2. (
)
3.
.. CaCO3 sevelamer

: Ca+2>10.6 mg/dL




:
PTH-related protein

IL-1 and IL-6

TNF

Ca2+

5%

10%

10%

11%

H. Milionis et al: Southern Med 2002;95: 1280-1287

Ca2+
PO43 PTH

Ca2+
(<100 mg/24h)
Ca2+ /
(<0.01)
FECa++<1%

24h

( 1/5
PTH)

+

calcium-sensing receptor

calcium-sensing


Henle:

Ca2+


CALCIUM-SENSING

N Engl J Med 2004;351: 362-369


1. [3-4
L 24h, 300-500 ml/h

, 100-200 ml/h]
2. /


3. [
(20-40 mg IV X
2-4)]
4. (
)

1. PAMIDRONATE DISODIUM
(PAMIDRONATE DISODIUM/FAULDING, 90 mg/vial)
(AREDIA/NOVARTIS, 30, 60, 90 mg/vial)
:
Ca2+ <12 mg/dL: 15-30 mg
Ca2+ 12-14 mg/dL: 30-60 mg
Ca2+ 14-16 mg/dL: 60-90 mg
Ca2+ >16 mg/dL: 90 mg


.. 60 mg 500 ml
5%
2-4 h, < 60 mg/h
[ 90 mg 1L ]
Ca2+

7
~ 2

2. ZOLEDRONIC ACID
(ZOMETA/NOVARTIS) , 4 mg/5 ml

5% [
Ringer], 1-4 mg 100 cc
, > 15

3.
(BONDRONAT/ROCHE) , 6 mg/6 ml
:
NaCl 0.9%
Ca2+ > 12 mg/dl 4 mg
Ca2+ < 12 mg/dl 2 mg
: 6 mg

500 ml
5%, 1-2 h

Ca2+, Mg2+, PO43

:


5. (amp 100 IU/1 ml)
: 4-8 IU/kg IV, IM SC/6-12 h
( )
: , ,


6. Gallium nitrate
7. Plicamycin
8. ( 20-50 mg 2,
,
,
D)
9. ( PO43- <3
mg/dL
)
10.

Ca2+ >12 mg/dL

<50

(2-3 L/)
NaCl (8-10 g/)

: Ca+2<8.4 mg/dL

1g/dL

.. 3 g/dL
Ca2+ 7 mg/dL

Ca2+ 0.8 mg/dL

Ca2+ 7.8 mg/dL

GADOLINIUM


Ca2+

Ca2+ 8.2 mg/dL

[FECa2+ 4% (>3%)]:

PTH (5 pg/ml)

M. Elisaf et al: Nephron 2001;89: 459-460

A 35-year-old man presented with a 2-day history of cramps and paresthesias in the arms,
predominantly involving the fingers

Athappan G and Ariyamuthu V. N Engl J Med 2009;360:e24


1.

QT IV



1. CALCIUM GLUCONATE 5%/DEMO
10 ml 500 mg
(2.23 mEq Ca2+ 1.115 mmol Ca2+)
4.5-9.0 mEq Ca2+ (2-4 mp)
10 12 amp 500 cc 4-6
h.

HCO3 Ca2+ 4-6 h
8-9 mg/dL
2. CALCIUM CHLORIDE 10%/DEMO


2.

3. :
Ca2+ (0.5-1 g X 3)
D ..
0.5-2 g/ :
Ca2+ 8.0-8.5 mg/dL