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The Value of Serum Magnesium Determination in Hypertensive Patients Receiving Diuretics

The Value of Serum Magnesium Determination in Hypertensive Patients Receiving Diuretics Abstract • Some clinicians contend that hypomagnesemia is a common problem in patients receiving diuretic therapy and that routine serum magnesium determinations may be indicated in such patients. We determined serum magnesium (Mg++) levels in 354 patients with uncomplicated hypertension. No significant difference was observed in the mean Mg++ between the 245 diuretic-treated patients and the 109 patients not receiving diuretics, 0.965 vs 0.97 mmol/L (1.93 vs 1.94 mEq/L). When analyzed by type of diuretic, there were statistically significant differences in the mean serum Mg++ concentrations between those receiving thiazides, 0.94 mmol/L (1.87 mEq/L); those receiving no diuretics, 0.97 mmol/L (1.94 mEq/L); and those receiving triamterene-containing diuretics, 1.01 mmol/L (2.01 mEq/L). These absolute differences, however, were clinically quite small, and hypomagnesemia was uncommon. Neither patient age, the duration of diuretic use, nor the serum potassium level correlated with Mg++. With respect to dose, those receiving 100 mg/d of hydrochlorothiazide had the lowest Mg++ concentrations and the greatest prevalence of hypomagnesemia (12%), defined as Mg++ less than 0.75 mmol/L (1.5 mEq/L). Serum Mg++ need not routinely be determined in patients with uncomplicated hypertension who are receiving triamterene-containing diuretics or low-dose (50 mg/d or less) hydrochlorothiazide. (Arch Intern Med 1987;147:1553-1556) References 1. Lim P, Jacob E: Magnesium deficiency in patients on long-term diuretic therapy for heart failure. Br Med J 1972;3:620-622.Crossref 2. Holden MP, Ionescu MI, Wooler GH: Magnesium in patients undergoing open-heart surgery. Thorax 1972;27:212-218.Crossref 3. Iseri LT, Freed J, Bures AR: Magnesium deficiency and cardiac disorders. Am J Med 1975;58:837-846.Crossref 4. Dyckner T, Wester PO: Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic therapy. Am Heart J 1979;97:12-18.Crossref 5. Sheehan J, White A: Diuretic-associated hypomagnesaemia. Br Med J 1982;285:1157-1159.Crossref 6. Cohen L, Kitzes R: Magnesium sulfate and digitalis-toxic arrhythmias. JAMA 1983;249:2808-2810.Crossref 7. Wong ET, Rude RK, Singer FR, et al: A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol 1983;79:348-352. 8. Ryan MP, Ryan MF, Counihan TB: The effect of diuretics on lymphocyte magnesium and potassium. Acta Med Scand 1981;647( (suppl) ):153-161. 9. Ryan MP, Devane J, Ryan MF, et al: Effects of diuretics on the renal handling of magnesium. Drugs 1984;28( (suppl 1) ):167-181.Crossref 10. Massry SG, Coburn JW: The hormonal and nonhormonal control of renal excretion of calcium and magnesium. Nephron 1973;10:66-112.Crossref 11. Eknoyan G, Suki WN, Martinez-Maldonado M: Effects of diuretics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs. J Clin Lab Med 1970;76:257-266. 12. Duarte CG: Effects of ethacrynic acid and furosemide on urinary calcium, phosphate and magnesium. Metabolism 1968;17:867-876.Crossref 13. Reyes AJ, Leary WP: Magnesium deficiency provoked by diuretics. S Afr Med J 1983;63:410-412. 14. Leary WP, Reyes AJ: Diuretic-induced magnesium losses. Drugs 1984;28( (suppl 1) ):183-186.Crossref 15. Abraham AS, Rosenman D, Meshulam Z, et al: Intracellular cations and diuretic therapy following acute myocardial infarction. Arch Intern-Med 1986;146:1301-1303.Crossref 16. Sherwood RA, Aryanayagam P, Rocks BF, et al: Hypomagnesium in the elderly. Gerontology 1986;32:105-109.Crossref 17. Smith WO, Kyriakopoulos AA, Hammarsten JF: Magnesium depletion induced by various diuretics. J Okla State Med Assoc 1962;55:248-250. 18. Seller RH, Ramirez-Muxo O, Brest AN, et al: Magnesium metabolism in hypertension. JAMA 1965;191:118-120.Crossref 19. Hollifield JW: Thiazide treatment of hypertension: Effects of thiazide diuretics on serum potassium, magnesium, and ventricular ectopy. Am J Med 1986;80( (suppl 4A) ):8-12.Crossref 20. Burch GE, Giles TD: The importance of magnesium deficiency in cardiovascular disease. Am Heart J 1977;94:649-657.Crossref 21. Seelig MS: Magnesium Deficiency in the Pathogenesis of Disease . New York, Plenum Publishing Corp, 1980, pp 219-252, 358-370. 22. Martin HE: Clinical magnesium deficiency. Ann NY Acad Sci 1969;162:891-900.Crossref 23. Calcium, magnesium, and diuretics. Br Med J 1975;1:170-171. 24. Bigg R: Magnesium: The neglected cation. Med J Aust 1980;2: 340-341. 25. Sheehan JP: Magnesium deficiency and diuretics. Br Med J 1983; 286:390.Crossref 26. Kaplan NM: Nondrug treatment of hypertension. Ann Intern Med 1985;102:359-373.Crossref 27. Whang R: Magnesium deficiency: Pathogenesis, prevalence, and clinical implications. Am J Med 1987;82( (suppl 3A) ):24-29.Crossref 28. Whang R: Routine serum magnesium determination: A continuing unrecognized need. Magnesium 1986;6:1-4. 29. Kupfer S, Kosovsky JD: Effects of cardiac glycosides on renal tubular transport of calcium, magnesium, inorganic phosphate, and glucose in the dog. J Clin Invest 1965;44:1132-1143.Crossref 30. Horton R, Biglieri EG: Effect of aldosterone on the metabolism of magnesium. J Clin Endocrinol 1962;22:1187-1192.Crossref 31. Wacker WEC: Magnesium and Man . Cambridge, Mass, Harvard University Press, 1980, pp 64-101. 32. Swales JD: Magnesium deficiency and diuretics. Br Med J 1982;285: 1377-1378.Crossref 33. Dyckner T, Wester PO: Magnesium deficiency in congestive heart failure. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):119-124.Crossref 34. Wester PO, Dyckner T: Diuretic treatment and magnesium losses. Acta Med Scand 1981;647:147-152. 35. Whang R, Oei TO, Aikawa JK, et al: Predictors of clinical hypomagnesemia: Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia. Arch Intern Med 1984;144:1794-1796.Crossref 36. Jackson CE, Meier DW: Routine serum magnesium analysis: Correlation with clinical state in 5100 patients. Ann Intern Med 1968;69:743-748.Crossref 37. Whang R, Chrysant S, Dillard B, et al: Hypomagnesemia and hypokalemia in 1000 treated ambulatory hypertensive patients. J Am Coll Nutr 1982;1:317-322.Crossref 38. Berglund G, Anderson O: Low doses of hydrochlorothiazide in hypertension: Antihypertensive and metabolic effects. Eur J Clin Pharmacol 1976;10:177-182.Crossref 39. Beerman B, Gruschinsky-Grind M: Antihypertensive effect of various doses of hydrochlorothiazide and its relation to the plasma level of the drug. Eur J Clin Pharmacol 1978;13:195-201.Crossref 40. Licht JH, Haley RJ, Pugh B, et al: Diuretic regimens in essential hypertension: A comparison of hypokalemic effects, BP control, and cost. Arch Intern Med 1983;143:1694-1699.Crossref 41. Boyd JC, Bruns DE, Wills MR: Frequency of hypomagnesemia in hypokalemic states. Clin Chem 1983;29:178-179. 42. Wills MR: Magnesium and potassium: Interrelationships in cardiac disorders. Drugs 1986;31( (suppl 4) ):121-131.Crossref 43. Papademetriou V: Magnesium depletion and thiazide hypokalemia. Arch Intern Med 1986;146:1026.Crossref 44. Dyckner T, Wester PO: The relation between extra- and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. Acta Med Scand 1978;204:269-282.Crossref 45. Dyckner T, Wester PO: Intracellular magnesium loss after diuretic administration. Drugs 1984;28( (suppl 1) ):161-166.Crossref 46. Alcock NW: Development of methods for the determination of magnesium. Ann NY Acad Sci 1969;162:707-716.Crossref 47. Wester PO, Dyckner T: Problems with potassium and magnesium in diuretic-treated patients. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):59-65.Crossref 48. Caralis PV, Perez-Stable E: Electrolyte abnormalities and ventricular arrhythmias. Drugs 1986;31( (suppl 4) ):85-100.Crossref 49. Packer M, Gottlieb SS, Kessler PD: Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Am J Med 1986;80( (suppl 4A) ):23-29.Crossref 50. Hollifield JW: Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82( (suppl 3A) ):30-37.Crossref 51. Beller G, Hood W, Smith T, et al: Correlation of serum magnesium levels and cardiac digitalis intoxication. Am J Cardiol 1974;33:225-228.Crossref 52. Messerli FH, Schmieder R: Left ventricular hypertrophy: A cardiovascular risk factor in essential hypertension. Drugs 1986;31( (suppl 4) ):192-201.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Value of Serum Magnesium Determination in Hypertensive Patients Receiving Diuretics

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American Medical Association
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Copyright © 1987 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1987.00370090033006
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Abstract

Abstract • Some clinicians contend that hypomagnesemia is a common problem in patients receiving diuretic therapy and that routine serum magnesium determinations may be indicated in such patients. We determined serum magnesium (Mg++) levels in 354 patients with uncomplicated hypertension. No significant difference was observed in the mean Mg++ between the 245 diuretic-treated patients and the 109 patients not receiving diuretics, 0.965 vs 0.97 mmol/L (1.93 vs 1.94 mEq/L). When analyzed by type of diuretic, there were statistically significant differences in the mean serum Mg++ concentrations between those receiving thiazides, 0.94 mmol/L (1.87 mEq/L); those receiving no diuretics, 0.97 mmol/L (1.94 mEq/L); and those receiving triamterene-containing diuretics, 1.01 mmol/L (2.01 mEq/L). These absolute differences, however, were clinically quite small, and hypomagnesemia was uncommon. Neither patient age, the duration of diuretic use, nor the serum potassium level correlated with Mg++. With respect to dose, those receiving 100 mg/d of hydrochlorothiazide had the lowest Mg++ concentrations and the greatest prevalence of hypomagnesemia (12%), defined as Mg++ less than 0.75 mmol/L (1.5 mEq/L). Serum Mg++ need not routinely be determined in patients with uncomplicated hypertension who are receiving triamterene-containing diuretics or low-dose (50 mg/d or less) hydrochlorothiazide. (Arch Intern Med 1987;147:1553-1556) References 1. Lim P, Jacob E: Magnesium deficiency in patients on long-term diuretic therapy for heart failure. Br Med J 1972;3:620-622.Crossref 2. Holden MP, Ionescu MI, Wooler GH: Magnesium in patients undergoing open-heart surgery. Thorax 1972;27:212-218.Crossref 3. Iseri LT, Freed J, Bures AR: Magnesium deficiency and cardiac disorders. Am J Med 1975;58:837-846.Crossref 4. Dyckner T, Wester PO: Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic therapy. Am Heart J 1979;97:12-18.Crossref 5. Sheehan J, White A: Diuretic-associated hypomagnesaemia. Br Med J 1982;285:1157-1159.Crossref 6. Cohen L, Kitzes R: Magnesium sulfate and digitalis-toxic arrhythmias. JAMA 1983;249:2808-2810.Crossref 7. Wong ET, Rude RK, Singer FR, et al: A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients. Am J Clin Pathol 1983;79:348-352. 8. Ryan MP, Ryan MF, Counihan TB: The effect of diuretics on lymphocyte magnesium and potassium. Acta Med Scand 1981;647( (suppl) ):153-161. 9. Ryan MP, Devane J, Ryan MF, et al: Effects of diuretics on the renal handling of magnesium. Drugs 1984;28( (suppl 1) ):167-181.Crossref 10. Massry SG, Coburn JW: The hormonal and nonhormonal control of renal excretion of calcium and magnesium. Nephron 1973;10:66-112.Crossref 11. Eknoyan G, Suki WN, Martinez-Maldonado M: Effects of diuretics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs. J Clin Lab Med 1970;76:257-266. 12. Duarte CG: Effects of ethacrynic acid and furosemide on urinary calcium, phosphate and magnesium. Metabolism 1968;17:867-876.Crossref 13. Reyes AJ, Leary WP: Magnesium deficiency provoked by diuretics. S Afr Med J 1983;63:410-412. 14. Leary WP, Reyes AJ: Diuretic-induced magnesium losses. Drugs 1984;28( (suppl 1) ):183-186.Crossref 15. Abraham AS, Rosenman D, Meshulam Z, et al: Intracellular cations and diuretic therapy following acute myocardial infarction. Arch Intern-Med 1986;146:1301-1303.Crossref 16. Sherwood RA, Aryanayagam P, Rocks BF, et al: Hypomagnesium in the elderly. Gerontology 1986;32:105-109.Crossref 17. Smith WO, Kyriakopoulos AA, Hammarsten JF: Magnesium depletion induced by various diuretics. J Okla State Med Assoc 1962;55:248-250. 18. Seller RH, Ramirez-Muxo O, Brest AN, et al: Magnesium metabolism in hypertension. JAMA 1965;191:118-120.Crossref 19. Hollifield JW: Thiazide treatment of hypertension: Effects of thiazide diuretics on serum potassium, magnesium, and ventricular ectopy. Am J Med 1986;80( (suppl 4A) ):8-12.Crossref 20. Burch GE, Giles TD: The importance of magnesium deficiency in cardiovascular disease. Am Heart J 1977;94:649-657.Crossref 21. Seelig MS: Magnesium Deficiency in the Pathogenesis of Disease . New York, Plenum Publishing Corp, 1980, pp 219-252, 358-370. 22. Martin HE: Clinical magnesium deficiency. Ann NY Acad Sci 1969;162:891-900.Crossref 23. Calcium, magnesium, and diuretics. Br Med J 1975;1:170-171. 24. Bigg R: Magnesium: The neglected cation. Med J Aust 1980;2: 340-341. 25. Sheehan JP: Magnesium deficiency and diuretics. Br Med J 1983; 286:390.Crossref 26. Kaplan NM: Nondrug treatment of hypertension. Ann Intern Med 1985;102:359-373.Crossref 27. Whang R: Magnesium deficiency: Pathogenesis, prevalence, and clinical implications. Am J Med 1987;82( (suppl 3A) ):24-29.Crossref 28. Whang R: Routine serum magnesium determination: A continuing unrecognized need. Magnesium 1986;6:1-4. 29. Kupfer S, Kosovsky JD: Effects of cardiac glycosides on renal tubular transport of calcium, magnesium, inorganic phosphate, and glucose in the dog. J Clin Invest 1965;44:1132-1143.Crossref 30. Horton R, Biglieri EG: Effect of aldosterone on the metabolism of magnesium. J Clin Endocrinol 1962;22:1187-1192.Crossref 31. Wacker WEC: Magnesium and Man . Cambridge, Mass, Harvard University Press, 1980, pp 64-101. 32. Swales JD: Magnesium deficiency and diuretics. Br Med J 1982;285: 1377-1378.Crossref 33. Dyckner T, Wester PO: Magnesium deficiency in congestive heart failure. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):119-124.Crossref 34. Wester PO, Dyckner T: Diuretic treatment and magnesium losses. Acta Med Scand 1981;647:147-152. 35. Whang R, Oei TO, Aikawa JK, et al: Predictors of clinical hypomagnesemia: Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia. Arch Intern Med 1984;144:1794-1796.Crossref 36. Jackson CE, Meier DW: Routine serum magnesium analysis: Correlation with clinical state in 5100 patients. Ann Intern Med 1968;69:743-748.Crossref 37. Whang R, Chrysant S, Dillard B, et al: Hypomagnesemia and hypokalemia in 1000 treated ambulatory hypertensive patients. J Am Coll Nutr 1982;1:317-322.Crossref 38. Berglund G, Anderson O: Low doses of hydrochlorothiazide in hypertension: Antihypertensive and metabolic effects. Eur J Clin Pharmacol 1976;10:177-182.Crossref 39. Beerman B, Gruschinsky-Grind M: Antihypertensive effect of various doses of hydrochlorothiazide and its relation to the plasma level of the drug. Eur J Clin Pharmacol 1978;13:195-201.Crossref 40. Licht JH, Haley RJ, Pugh B, et al: Diuretic regimens in essential hypertension: A comparison of hypokalemic effects, BP control, and cost. Arch Intern Med 1983;143:1694-1699.Crossref 41. Boyd JC, Bruns DE, Wills MR: Frequency of hypomagnesemia in hypokalemic states. Clin Chem 1983;29:178-179. 42. Wills MR: Magnesium and potassium: Interrelationships in cardiac disorders. Drugs 1986;31( (suppl 4) ):121-131.Crossref 43. Papademetriou V: Magnesium depletion and thiazide hypokalemia. Arch Intern Med 1986;146:1026.Crossref 44. Dyckner T, Wester PO: The relation between extra- and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. Acta Med Scand 1978;204:269-282.Crossref 45. Dyckner T, Wester PO: Intracellular magnesium loss after diuretic administration. Drugs 1984;28( (suppl 1) ):161-166.Crossref 46. Alcock NW: Development of methods for the determination of magnesium. Ann NY Acad Sci 1969;162:707-716.Crossref 47. Wester PO, Dyckner T: Problems with potassium and magnesium in diuretic-treated patients. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):59-65.Crossref 48. Caralis PV, Perez-Stable E: Electrolyte abnormalities and ventricular arrhythmias. Drugs 1986;31( (suppl 4) ):85-100.Crossref 49. Packer M, Gottlieb SS, Kessler PD: Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Am J Med 1986;80( (suppl 4A) ):23-29.Crossref 50. Hollifield JW: Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82( (suppl 3A) ):30-37.Crossref 51. Beller G, Hood W, Smith T, et al: Correlation of serum magnesium levels and cardiac digitalis intoxication. Am J Cardiol 1974;33:225-228.Crossref 52. Messerli FH, Schmieder R: Left ventricular hypertrophy: A cardiovascular risk factor in essential hypertension. Drugs 1986;31( (suppl 4) ):192-201.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1987

References