Magnesium Balance

Natural repletion

The low incidence of SIDS in Hong Kong, (Caddell’s ref. 31 in this issue, p 219) reminds me of a patient, especially since this observation has been confirmed in a subsequent prospective investigation.(16)

A patient with chronic asthma improved significantly while in China on sabbatical leave for 1 year. She was able to discontinue all of her many medications. Of course, this could also be environmental. However, she lost her PMS and migraine. On returning to the United States, she resumed her dieting for weight loss, which included phosphate-rich diet soda, and her asthma, PMS, and migraine returned. She is scheduled for a Mg load test.

THE VULNERABLE NEONATE

Table 2 lists numerous risk factors for the development of SIDS. Dr. Caddell mentioned the association of earlier apnea neonatorum in infants with subsequent SIDS. It should also be noted that the incidence of SIDS is seven times greater in infants with bronchopulmonary dysplasia.(17) Although there is no doubt in my mind that babies sleeping face down on soft cushions filled with polystyrene beads might die of suffocation,(18) by far more of the 7000 classified as SIDS are likely to have a Mg deficiency because of a chronic negative Mg balance in their mothers.

Crib death and milk hypersensitivity

Perish et al.,(19) published in 1960 a hypothesis and guinea pig experimental data suggesting that milk antibodies make the infant susceptible to anaphylaxis microaspiration while asleep or, in the case of milk-immunized guinea pigs challenged with milk, while under light anesthesia. The modified anaphylaxis hypothesis was reevaluated again in 1982 by Coombs, one of the previous authors.(20) This work must be watched by the allergist and immunologist but it does not yet lend itself to preventive measures, even though milk allergy is frequent enough to result in two articles in this issue of Pediatric Asthma, Allergy & Immunology from the Eastern and Western parts of the United States.

Magnesium and asthma

There are now 27 references on Mg and asthma, and a list is available on request from the author. Mg is more than a bronchodilator in asthmatics. Aerosolized MgSO4 has been demonstrated to inhibit both histamine(21-23) and methacholine(24)-induced bronchial hyperreactivity (BHR). Moreover, a chronic asthmatic patient following an acute episode of asthma had significant BHR, which disappeared after parental repletion of Mg deficiency.(25)

SUMMARY

These comments illustrate why all physicians need to know more about Mg and why I suggest that real consideration must be given to the state of Mg balance in more of our patients, especially those with two or more factors, as illustrated in Tables 1 and 2. Those with diabetes mellitus, renal tubular disorders, alcoholism, hypercalcemia, and aldosteronism also are likely to develop clinical hypomagnesemia, all of which must also be considered risk factors.

ACKNOWLEDGMENT

This work was supported in part by a research grant from Fleming & Co., Inc.

REFERENCES

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7. Ryzen E, Servis KL, Rude RK. Effect of intravenous epinephrine on serum magnesium and full intracellular red blood cell magnesium concentrations by nuclear magnetic resonance. J Am Coll Nutr 1990;9:114-119.

8. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia. JAMA 1990;263:3063-3064.

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10. Ryzen E. Magnesium homeostasis in critically ill patients. Magnesium 1989;8:201-212.

11. Nicar MJ, Pak CYC. Oral magnesium load test for the assessment of intestinal magnesium absorption. Miner Electrolyte Metab 1982;8:44-51.

12. Lindberg JS, Zobitz MM, Poindextar JR, Pak CYC. Magnesium bioavailability from magnesium citrate and magnesium oxide. J Am Coll Nutr 1990;9:48-55.

13. Toufexis A. Forget about losing those last 10 pounds. Time 1991;138:50-51.

14. Lissner L, Odell PM, D’Agostino RB, Stokes J III, Kreger BE, Belanger AJ, Brownell KD. Variability of body weight and health outcomes in the Framingham population. N Engl J Med 1991;324:1839-1844.

15. Fauk D, Fehlinger R, Becker R, Meyer E, Kemnitz C, Reichmuth B, Stephan A. Transient cerebral ischaemic attacks and calcium-magnesium imbalance: Clinical and paraclinical findings in 106 patients under 50 years of age. Magnesium Res 1991;4:53-58.

16. Lee NNY, Chan YF, Davies DP, Lau E, Yik DCP. Sudden infant death syndrome in Hong Kong: Confirmation of low incidence. Br Med J 1989;298:721.

17. Werthammer J, Brown ER, Neff RK, Taeusch HW Jr. Sudden infant death syndrome in infants with bronchopulmonary dysplasia. Pediatrics 1982;69:301-304.

18. Kemp JS, Thach BT. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med 1991;324:1858-1864.

19. Parish WE, Barrett AM, Coombs RRA, Gunther M, Camps FE. Hypersensitivity to milk and sudden death in infancy. Lancet 1960;2:1106-1110.

20. Coombs RRA, McLaughlan P. The enigma of cot death: Is the modified-anaphylaxis hypothesis an explanation for some cases. Lancet 1982;1:1388-1389.

21. Rolla G, Bucca C, Bugiani M, Arossa W, Elia C, Cicconi C. Magnesium increased histamine threshold in asthmatic subjects (Abstract). Bull Eur Physiopath Respir 1986;22(suppl 8):48S.

22. Rolla G, Bucca C, Bugiani M, Arossa W, Spinaci S. Reduction of histamine-induced bronchoconstriction by magnesium in asthmatic subjects. Allergy 1987;42:186-188.

23. Rolla G, Bucca C, Carie E. Dose-related effect of inhaled magnesium sulfate on histamine challenge in asthmatics. Drugs Exp Clin Res 1988;14:609-612.

24. Rolla G, Bucca C, Arossa W, Bugiani M. Magnesium attenuates methacholine-induced bronchoconstriction in asthmatics. Magnesium 187;6:201=204.

25. Rolla G, Bucca C. Hypomagnesemia and bronchial hyperreactivity. A case report. Allergy 1989;44:519-521.

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