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Diagnosing magnesium deficiency
Letters
Steroids
to the Editor
in myocardial
disease
To the Editor: I read with interest the article by Greenwood, Nadas, and Fyler (The clinical course of primary myocardial disease in infants and children, AMERICAN HEART JOURNAL 92549-560,
1976.). There is one statement made by the authors which, I think, requires some clarification and explanation. The statement concerning the treatment of children with myocardial disease with steroids may be misleading. The authors do not state what dose or range of steroids was generally used in these patients. This information is, I think, of critical importance to the implied statement on the efficacy of steroids. There is, as the authors do mention, controversy concerning the use of steroids in these conditions. Part of this controversy is dose. Some experts purport the use of pharmacologic or physiologic doses of steroids (equivalent to 150 mg./Kg. of hydrocortisone intravenously) for use in cardiovascular emergencies,lel rather than usual doses of parenteral steroids to provide optimal effect with minimal problems. I don’t know whether or not, during the times of data collection for this study, the use of these physiologic doses of steroids was considered and carried out in these patients. This is pertinent information.
Salvatore J. Giorgianni, Jr., Pharm.D. Clinical Coordinator Pharmacy Services Lenox Hill Hospital 100 E. 77th St. New York, N. Y. 10021
2.
3.
Carlo Tommaso, M.D. Joseph R. Tucci, M.D. Dept. of Medicine Roger Williams General Hospital Brown University Prouidence, R. I. REFERENCES 1.
REFERENCES 1.
The diagnosis of magnesium deficiency can be difficult. It is clear that serum magnesium levels do not always correlate with total body levels of magnesium.’ Hypomagnesemia is certainly consistent with a magnesium deficient state, but a normal serum magnesium level does not rule it out. Measurement of urinary magnesium may also be helpful in the diagnosis. In addition to serum and urine measurements, Thoren” has described a test that utilizes the urinary excretion of magnesium following an intravenous load which may be a more sensitive index of magnesium deficiency. In this test, 6 mg. per kilogram body weight is infused intravenously over a 3 to 4 hour period and the ensuing 24-hour urine collected and analyzed for its magnesium content. Accordingly, if tissue stores of magnesium are adequate, more than 80 per cent of an intravenous dose is excreted within the 24-hour period. Experience with this appears to be limited; however, we feel that to more adequately document a magensium deficient state, serum and urine magnesium measurements, a magnesium infusion test, and of course, the response to magnesium therapy may be more revealing than a single serum magnesium measurement. We appreciate that in many instances these may not be particularly practicable.
Melby, J. C.: Adrenocorticosteroids in medical emergencies, Med. Clin. North Am. 45875, 1961. Shoemaker, W. C.: Hemodynamic and oxygen transport patterns of common shock syndromes. From the Proceedings of a symposium on recent research developments and current clinical practice in shock, The Upjohn Company, 1975. Lillehei, R.: Steroids and shock controversy, Med. Opinion, August, 1971.
Burch, G. magnesium
E., and Giles, deficiency in
T. D.: The cardiovascular
importance disease,
of
AM.
HEART J.94:649,1977. 2.
3.
Vendt, E. R.: Disorders of calcium, phosphorus, and magnesium metabolism, in Maxwell, M. H., and Kleeman, C. R., eds., Clinical disorders of fluid and electrolyte metabolism, New York, 1972, McGraw-Hill Book Company, Inc., pp. 460-503. (Editorial): Magnesium deficiency, Lancet 1:523, 1976.
Lymphatic
drainage
of the
brain
and catarrhea
To the Editor: Diagnosing
magnesium
deficiency
To the Editor: With the large number of patients who are now receiving diuretic therapy in clinical practice, the incidence of occult magnesium deficiency may indeed be much more common than is generally appreciated. The comprehensive review by Burch and Giles’ brought out very effectively the possible role of magnesium deficiency in the genesis of alcoholic cardiomyopathy, ischemic heart disease, arrhythmias, and electrocardiographic abnormalities. We feel that an equally important aspect is the diagnosis of magnesium deficiency, and this appears to have received inadequate emphasis in this article.
274
Fold? states that the existence of brain-lymphatic connections has been well established for 100 years; however, this had already been worked out by the Greeks 2500 years ago. The brain was said to attract moisture from the stomach, forming phlegm, which then drained out into the eyes, nose, ears and throat, into the cervical glands, or down into the lungs and stomach. Lymphostatic encephalopathy was well recognized; lethargy and convulsions were attributed to damming up of phlegm in the brain. In goats with convulsions, Hippocrates noted excess fluid in the subarachnoid spaces; significantly, although the brains were also infected, he placed no importance on this. The related condition of benign intracranial hypertension was also known, and the dimness of
August,
1978, Vol. 96, No. 2
Steroids
to the Editor
in myocardial
disease
To the Editor: I read with interest the article by Greenwood, Nadas, and Fyler (The clinical course of primary myocardial disease in infants and children, AMERICAN HEART JOURNAL 92549-560,
1976.). There is one statement made by the authors which, I think, requires some clarification and explanation. The statement concerning the treatment of children with myocardial disease with steroids may be misleading. The authors do not state what dose or range of steroids was generally used in these patients. This information is, I think, of critical importance to the implied statement on the efficacy of steroids. There is, as the authors do mention, controversy concerning the use of steroids in these conditions. Part of this controversy is dose. Some experts purport the use of pharmacologic or physiologic doses of steroids (equivalent to 150 mg./Kg. of hydrocortisone intravenously) for use in cardiovascular emergencies,lel rather than usual doses of parenteral steroids to provide optimal effect with minimal problems. I don’t know whether or not, during the times of data collection for this study, the use of these physiologic doses of steroids was considered and carried out in these patients. This is pertinent information.
Salvatore J. Giorgianni, Jr., Pharm.D. Clinical Coordinator Pharmacy Services Lenox Hill Hospital 100 E. 77th St. New York, N. Y. 10021
2.
3.
Carlo Tommaso, M.D. Joseph R. Tucci, M.D. Dept. of Medicine Roger Williams General Hospital Brown University Prouidence, R. I. REFERENCES 1.
REFERENCES 1.
The diagnosis of magnesium deficiency can be difficult. It is clear that serum magnesium levels do not always correlate with total body levels of magnesium.’ Hypomagnesemia is certainly consistent with a magnesium deficient state, but a normal serum magnesium level does not rule it out. Measurement of urinary magnesium may also be helpful in the diagnosis. In addition to serum and urine measurements, Thoren” has described a test that utilizes the urinary excretion of magnesium following an intravenous load which may be a more sensitive index of magnesium deficiency. In this test, 6 mg. per kilogram body weight is infused intravenously over a 3 to 4 hour period and the ensuing 24-hour urine collected and analyzed for its magnesium content. Accordingly, if tissue stores of magnesium are adequate, more than 80 per cent of an intravenous dose is excreted within the 24-hour period. Experience with this appears to be limited; however, we feel that to more adequately document a magensium deficient state, serum and urine magnesium measurements, a magnesium infusion test, and of course, the response to magnesium therapy may be more revealing than a single serum magnesium measurement. We appreciate that in many instances these may not be particularly practicable.
Melby, J. C.: Adrenocorticosteroids in medical emergencies, Med. Clin. North Am. 45875, 1961. Shoemaker, W. C.: Hemodynamic and oxygen transport patterns of common shock syndromes. From the Proceedings of a symposium on recent research developments and current clinical practice in shock, The Upjohn Company, 1975. Lillehei, R.: Steroids and shock controversy, Med. Opinion, August, 1971.
Burch, G. magnesium
E., and Giles, deficiency in
T. D.: The cardiovascular
importance disease,
of
AM.
HEART J.94:649,1977. 2.
3.
Vendt, E. R.: Disorders of calcium, phosphorus, and magnesium metabolism, in Maxwell, M. H., and Kleeman, C. R., eds., Clinical disorders of fluid and electrolyte metabolism, New York, 1972, McGraw-Hill Book Company, Inc., pp. 460-503. (Editorial): Magnesium deficiency, Lancet 1:523, 1976.
Lymphatic
drainage
of the
brain
and catarrhea
To the Editor: Diagnosing
magnesium
deficiency
To the Editor: With the large number of patients who are now receiving diuretic therapy in clinical practice, the incidence of occult magnesium deficiency may indeed be much more common than is generally appreciated. The comprehensive review by Burch and Giles’ brought out very effectively the possible role of magnesium deficiency in the genesis of alcoholic cardiomyopathy, ischemic heart disease, arrhythmias, and electrocardiographic abnormalities. We feel that an equally important aspect is the diagnosis of magnesium deficiency, and this appears to have received inadequate emphasis in this article.
274
Fold? states that the existence of brain-lymphatic connections has been well established for 100 years; however, this had already been worked out by the Greeks 2500 years ago. The brain was said to attract moisture from the stomach, forming phlegm, which then drained out into the eyes, nose, ears and throat, into the cervical glands, or down into the lungs and stomach. Lymphostatic encephalopathy was well recognized; lethargy and convulsions were attributed to damming up of phlegm in the brain. In goats with convulsions, Hippocrates noted excess fluid in the subarachnoid spaces; significantly, although the brains were also infected, he placed no importance on this. The related condition of benign intracranial hypertension was also known, and the dimness of
August,
1978, Vol. 96, No. 2