Title: A Study on Occurrence of Hypomagnesemia in Hypokalemia in a Tertiary Care Center
Authors: Dr Deborah D’silva, Dr Manjunath J, Dr Jayaprakash Alva
DOI: https://dx.doi.org/10.18535/jmscr/v8i4.06
Abstract
Introduction
Hypokalemia is a common electrolyte abnormality encountered in clinical practice. It has been found in up to 21% of hospitalized patients according to reports from studies done mainly among Caucasians.(1,2) The concentration of potassium (K) in the serum is a balance among intake, ex-cretion, and distribution between the ex-tra- and intracellular spaces.(3) Hypokalemia is associated with alterations in the function of several organs systems, especially neuromuscular and cardiovascular systems, with resultant increase in morbidity and mortality in affected patients.(4)
The effective treatment of hypokalemia requires the identification of its cause. Hypokalemia has been found to be frequently associated with hypomagnesemia in hospitalized patients according to previous reports mainly from studies done among Caucasians.(5-9) Magnesium deficiency, when present, worsens hypokalemia by aggravating renal wasting of potassium and enhances the adverse effects of hypokalemia.
Because both hypokalemia and hypomagnesemia can be induced by the same mechanisms (e.g., diuretic administration, primary hyperaldosteronism, renal tubular acidosis) attention in recent years has been focused on their co-occurrence.(6)
Clinically, combined potassium and magnesium deficiency is most frequently observed in individuals receiving loop orthiazide diuretic therapy. Other causes include diarrhea; alcoholism; intrinsic renal tubular transport disorders such as Bartter and Gitelman syndromes; and tubular injuries from nephrotoxic drugs, including amino glycosides, amphotericin B, cisplatin, etc. Concomitant magnesium deficiency has long been appreciated to aggravate hypokalemia.(10)
An observational study supported the view that uncorrected magnesium (Mg) deficiency impairs repletion of cellular potassium (K). Concomitant Mg deficiency in K-depleted patients ranged from 38% to 42%. Hypokalemia associated with magnesium deficiency is often refractory totreatment with K. Co-administration of magnesium is essential for correcting the hypokalemia.(7)
Detection of coexisting hypomagnesemia and early intervention is crucial for effective treatment and prevention of complications hypokalemia on target tissues.[12]
Indian Data on the frequency of hypomagnesemia among hospitalized patients with hypokalemia in are limited, as most hospitals do not routinely measure plasma magnesium.
