Updated July 17, 2006
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What does Jon recommend?
I am not a doctor. I believe magnesium is one of the 3 really great supplements for all people with heart failure. I take small amounts 3 times a day: 100mg in my multi-vitamin/multi-mineral pill after breakfast and again after dinner; and 65mg once just before bed with calcium and zinc. If you have heart failure, I recommend taking 250mg a day whether you exercise or not. Large amounts will just give you diarrhea.

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 Selenium

January 30, 1998 - Selenium is an element. In the body, the highest levels of selenium are found in the kidney, followed by the liver, muscle, and skin. Muscle contains almost 50% of total body selenium. Some selenium is also contained in the spleen, heart, nails, tooth enamel and testes.
     Total body content of selenium varies with the relative amount found in the soil. In North America, body content is about 13 to 20mg for adults, while in New Zealand the body content is about 3 to 6mg. Although selenium deficiency is rare in the United States, it has been linked to diseases such as Keshan disease - a juvenile cardiomyopathy, and to Kashan-Beck disease - an osteoarthritis. Episodes of serious illness can lower your selenium levels. Selenium is available as an pill (elemental selenium) or as an injection (selenious acid or selenite).
Deficiency Selenium is requied for an enzyme to work that protects cells from peroxide-caused damage. This is similar to the action of vitamin E. Symptoms of too-little selenium include muscle weakness and pain, infection, reduced pancreas function, macrocytosis (too many large red blood cells, like in anemia), and other health problems.
Uses and Benefits Selenium is an essential nutrient. It may be an antioxidant. Selenium supplementats are required in long-term tube feeding (TPN or total parenteral nutrition). A large, long-term human study done in China showed that selenium supplements reduced liver cancer.
Warnings GI disease or kidney dysfunction may cause high levels of selenium so patients with these problems should reduce or stop their selenium supplements. No drug interactions with selenium are known. At recommended doses, selenium has no ill effects. However, selenium poisoning causes chronic skin conditions, diarrhea, fatigue, weak fingernails, garlic odor on both breath and sweat, hair loss, irritability, a metallic taste, and nausea.
IV Dose To treat selenium deficiency, an IV (intravenous) form is used, called selenious acid. IV therapy is only recommended when selenium pills cannot be used for some reason. Adults would receive 100 micrograms of elemental selenium per day by IV for 24 to 31 days. Children would receive 3 micrograms elemental selenium/kg body weight per day by IV.
Oral dose The recommended daily allowance (RDA) of selenium for pill supplementation is:

Source: GSM's Integrated Medical Curriculum

 Chromium

August 19, 1999 - Chromium (in its trivalent state: Cr3+) is an element required for proper metabolism of carbohydrates, cholesterol, and nucleic acid. Sources of chromium include whole grains, egg yolks, brewer's yeast, liver, meats, nuts and potatoes with skin.
Deficiency Symptoms of too-little chromium are usually only seen in people eating diets high in refined foods or who are receiving long-term tube feeding. Deficiency may show up as reduced glucose tolerance, glycosuria (large amounts of sugar in the urine), and insulin resistance. Side effects of too-little chromium may include peripheral neuropathy (nerve problems) and encephalopathy (degenerative brain disease).
Supplements Chromium supplements will probably only help you if you are deficient in chromium and if that deficiency is part of your problem. Limited studies - small in size - have reported that patients with type 2 diabetes or steroid-induced diabetes may improve sugar control and cholesterol levels by taking chromium picolinate supplements. There is no proof for claims that chromium reduces body fat.
     Chromium's role is not understood. After absorption, it is carried in the blood by transferrin. While chromium competes with iron for transferrin binding sites, chromium supplements do not seem to change iron metabolism.
     Chromium's relationship to glucose metabolism (the body's use of sugars) is partly understood. The glucose tolerance factor (GTF) requires chromium. GTF is required for insulin action on cell surfaces. GTF aids the binding of insulin to insulin receptors in tissues and helps glucose travel across cell membranes. Chromium may also influence cholesterol and triglyceride metabolism by affecting enzymes that regulate the body's production of cholesterol. Increased HDL has been reported after chromium supplementation. Chromium also seems to be important for proper nerve function.
     Only a small amount of the chromium in your diet is absorbed by the intestines: 1% to 10% of food chromium content. Chromium pills are made of picolinate and nicotinate salts to improve how your body absorbs them (10% to 50%). Atomic spectrometry can accurately measure chromium levels in blood, urine or hair, but this may not relate to the total body level of chromium. Chromium seems to be distributed throughout the body's tissues. Patients with Type 2 diabetes seem to urinate greater amounts of chromium than healthy people, which may lead to a deficiency in these diabetics.
 
Source: GSM's Integrated Medical Curriculum

 Calcium

November 17, 1999 - Calcium is usually replaced by taking a supplement called calcium carbonate, like Tumms. In fact, that is the primary use of products like Tumms and Rolaids. The bioavailability of calcium is greater from calcium carbonate than from other forms of calcium.
     Calcium is the fifth most abundant element in your body. It is a metal necessary for maintaining the nervous, muscular, and skeletal systems; and for cell wall and blood vessel health. Calcium's role in bone and muscle strength is well known, but calcium is also important for blood clotting, nerve function, and electrical conduction in the heart. Calcium can be used to control heart arrhythmias associated with low potassium levels.
     Growing evidence suggests that calcium is a main ingredient in the plaques that clog arteries, although this does not seem related to taking calcium supplements. Parathyroid hormone (PTH), vitamin D, glucocorticoids and magnesium influence calcium balance in the body.
Dose The recommended daily allowance (RDA) of calcium supplements are:

Warning IV calcium can be dangerous in patients taking digoxin.Do not take a calcium supplement within one hour of taking Captopril (an ACE inhibitor). The calcium may slow your body's absorption of the drug. Taking calcium supplements can lower your blood level of digoxin, so keep your weekly intake of calcium consistent. Do not take coated pills like Ecotrin-type aspirin within one hour of calcium carbonate. Avoid taking calcium with foods containing large amounts of oxalic acid like spinach and rhubarb; phytic acid as in brans and cereals; or phosphorus as in milk and dairy products.
Equivalence Tums tablets have calcium equivalent to 10 mEq per 500mg tablet. Each Tums Extra-Strength tablet has 15 mEq and each Tums Ultra tablet has 20 mEq.
     Take antacid-type supplements on an empty stomach to maximize the amount of calcium absorbed.
 
Source: GSM's Integrated Medical Curriculum

 ACE Inhibitors Deplete Zinc

February 17, 1998 - We studied the effect of 6 months of ACE inhibitor use on zinc levels in patients with high blood pressure. Two ACE inhibitors - captopril (Capoten) and enalapril (Vasotec) - were used. Patients were randomly divided into 2 groups. Sixteen patients took captopril and 18 took enalapril. Ten healthy people were controls. Before starting treatment and again 6 months later, zinc level was measured in the blood, monocyte cells, and in a 24 hour urine collection.
     A unusual amount of zinc was eliminated through the urine after 6 months in the captopril group only. However, zinc levels in monocyte cells went down significantly in both groups. Taking captopril or enalapril may result in zinc deficiency.
 
Title: Effects of captopril and enalapril on zinc metabolism in hypertensive patients.
Authors: Golik A, Zaidenstein R, Dishi V, Blatt A, Cohen N, Cotter G, Berman S, Weissgarten J. (Israel)
Source: J Am Coll Nutr 1998 Feb;17(1):75-8
PMID: 9477394

 ACE Inhibitors & Zinc Levels

July, 1996 - We studied the influence of ACE inhibitors on zinc metabolism. Thirty-one patients with high blood pressure were divided into 2 groups. Group one was 6 women and 10 men with an average age of 47 years. They took benazepril (Lotensin). Group 2 was 6 women and 9 men with an average age of 46 years. They took captopril (Capoten).
     This was a ranmdomized, double-blind trial. Group one took 10 mg benazepril once daily. Group 2 took 50 mg captopril once daily. If after 4 weeks of treatment blood pressure was well controlled, the same treatment was continued for another 4 weeks. In patients whose blood pressure was not well controlled at 4 weeks, drug dose was doubled and continued for another 4 weeks.
     Zinc was measured in blood, erythrocyte cells, and in a 24 hour urine collection. Kidney function was checked before the trial started and after 4 and 8 weeks of ACE inhibitor use.
     An unusual amount of zinc was passed through urine in both groups. Blood levels of zinc went down but erythrocyte levels remained unchanged. At 4 weeks, both groups' zinc levels were similar. However, at 8 weeks, blood levels of zinc went down more in the captopril group. Kidney function remained unchanged throughout the study. ACE inhibitor therapy may influence zinc metabolism.
 
Title: Influence of angiotensin I converting enzyme inhibitors on selected parameters of zinc metabolism.
Author: Peczkowska M. (Poland)
Source: Pol Arch Med Wewn 1996 Jul;96(1):32-8
PMID: 8966143

 Potassium & Magnesium Levels No Joke

February 16, 2000 by Jon - During my research, I discovered that extreme changes in your level of K (potassium) or Mg (magnesium) can actually kill you by causing heart arrhythmias or by drastically changing your heart rate. ACE inhibitors and diuretics like Lasix and Aldactone affect your electrolyte levels so you should have your blood tested at least once every 3 months for safety. Even moderate potassium depletion can prevent your heart from relaxing correctly between beats. Low potassium levels can also cause kidney failure.
Hypokalemia is dangerously low potassium - a blood potassium level below 3.5 mEq/L; At 2.8 mEq/L or less, you are in trouble.
Hyperkalemia is dangerously high potassium - a blood potassium level above 5.5 mEq/L; at 6 mEq/L or more, you are in trouble.
Both too-little and too-much potassium can cause deadly heart arrhythmias. As many as 40% of all CHFers die from arrhythmias, so anything that causes them is to be avoided. Also, potassium without magnesium will not enter cells so also be careful of your magnesium levels - read on. Digoxin lowers the magnesium level in your cells, causing increased loss of magnesium in the urine. Too-low magnesium levels are very common in patients taking digoxin.
     Please be sure your doctor regularly checks your blood level of these electrolytes. The next medical study - from late last year - drives home this point.

 Potassium Blood Testing Critical For CHFers

September 28, 1999 - The SOLVD trial showed higher risk for arrhythmic death in CHF patients treated with diuretics. Dr. Howard Cooper reported results of an analysis of 6000 patients with EFs less than 36%. Patients taking a diuretic at entry into the study were more likely to die from a heart arrhythmia.
     They found that use of loop diuretics like Lasix and Bumex was linked to this high risk. There was no increased risk of arrhythmic death linked to use of a potassium-sparing diuretic like thiazides alone or in combination with a loop type non-potassium-sparing diuretic.
     "This suggests that diuretic-induced electrolyte changes may result in fatal arrhythmias in CHF patients," Dr. Cooper said. "Careful monitoring of blood potassium levels is essential in all patients taking such diuretics," he added.
 
Source: Circulation 1999;100:1311-1315

 What Is An MEQ?

July, 2000 by Jon - mEq stands for milli-equivalent. This is the combining power of a substance relative to the activity of one milligram of hydrogen. In other words, One mEq = 23 mg of sodium, 39 mg of potassium, 75mg of potassium chloride (like we usually take as supplements), or 20 mg of calcium. An average 150 pound man has about 3500 mEq of potassium in his body. Dietary intake of potassium is usually between 40 and 150 mEq per day. It's usually used as mEq/L (mEq per liter of blood) when referring to potassium in the human body.
 
Source: The Merck Manual, 2000

 Magnesium

1996 - Almost all chemical reactions in the body require an enzyme system to take place. An enzyme system usually has 3 parts - a specific protein molecule, another smaller organic compound like a vitamin, and a charged mineral (electrolyte). Magnesium is a co-factor in more than 300 such enzyme reactions in the human body.
Deficiency causes Too-low magnesium can be caused by drugs, especially diuretics, some antibiotics, aminoglycosides, cisplatin, and cyclosporine. Alcoholism can also cause hypomagnesemia.
Deficiency symptoms What are some of the symptoms of magnesium deficiency? With regard to skeletal muscle, one may have twitches, cramps, muscle tension, muscle soreness, back aches, tension headaches and jaw pain. Also, one may experience chest tightness, like you can't take a deep breath. Sometimes a person sighs a lot. Symptoms may also involve smooth muscles, causing constipation, menstrual cramps, difficulty swallowing, sensitivity to light, or loud noises. Your central nervous system may be affected, causing insomnia, anxiety, and restlessness. Symptoms involving the peripheral nervous system include numbness, tingling, and sensations of vibration.
     Symptoms of the cardiovascular system include palpitations, heart arrhythmias, and angina (from spasms of the coronary arteries). Of course, not all these symptoms happen at the same time. Other general symptoms may include salt craving and breast tenderness.
Diagnosis How can a doctor diagnose magnesium deficiency? Unfortunately, normal lab testing isn't much use. Since magnesium is found mainly in the cells, the blood magnesium level may be normal even when your body is really low. Probably the best test is the magnesium loading test. In this test, the patient collects a 24 hour urine sample and the total magnesium is measured. The patient is then given an injection of a certain amount of magnesium and another 24 hour urine specimen is collected. The magnesium is again measured. If your body retains more than a certain amount of magnesium, then you are magnesium deficient, with your body holding on to the magnesium that was injected.
     Maybe the easiest way to diagnose too-little magnesium is when symptoms improve after taking magnesium supplements. Magnesium supplements are available in many forms. The cheapest is probably magnesium oxide, but this form is not absorbed as well as some other forms. Other forms include chelated magnesium, magnesium glycinate, and magnesium aspartate. The prescription form of magnesium chloride - called Slow-mag - is best.
DoseThe recommended daily allowance for magnesium is 350mg of elemental magnesium. It is important to distinguish between the amount of magnesium "complex" versus the amount of elemental or pure magnesium in a supplement. The important number is the elemental magnesium. A therapeutic is usually between 400 and 800 mg daily of elemental magnesium, taken in several smaller doses throughout the day. Too much will cause diarrhea. People with kidney failure must be more careful because their kidneys may have difficulty eliminating magnesium and a buildup could occur. Toxic levels of magnesium may suppress your nervous system and may even cause coma and death. This is extremely rare and only happens in patients with severe kidney failure. Doses of 1000mg per day are considered extremely safe.
 
Based loosely on: The Importance of Magnesium to Human Nutrition
Author: Michael Schechter, MD, FACAM

 Magnesium and Heart Patients

October, 1993 - Magnesium plays an important role in the cardiovascular system. Too-little magnesium has been linked with heart arrhythmia, increased death rate in CHF patients, and an increased death rate after acute heart attack. The research shows that magnesium supplements in these situations may be good for treating and preventing life-threatening arrhythmias. Magnesium supplements can be given safely either orally or by IV, depending on the situation.
 
Title: Magnesium in congestive heart failure, acute myocardial infarction and dysrhythmias.
Source: J Cardiovasc Nurs 8 (1): 19-31 (Oct 1993)
PMID: 8106895, MUID: 94149478

 Diuretics Deplete Magnesium

July, 1994 - Compared to 31 healthy people of the same age, muscle levels of magnesium and potassium were very low in 76 patients who had been on diuretics for 1 to 17 months. Thirty-six patients with low muscle magnesium levels took magnesium hydroxide pills for 2 to 12 weeks (20 people) or 26 weeks (16 people).
     After 2 to 12 weeks, muscle magnesium levels were higher but not back up to normal. After 26 weeks, the muscle levels of magnesium had been brought up to normal in most cases.
     Oral magnesium supplements can restore normal magnesium levels in people who are low due to diuretics. However, a patient must take oral magnesium supplements for 6 months before reaching normal levels.
 
Title: Oral magnesium supplementation to patients receiving diuretics--normalization of magnesium, potassium and sodium, and potassium pumps in the skeletal muscles
Authors: Dorup I, Skajaa K, Thybo NK
Source: Ugeskr Laeger 156 (27): 4007-4010 (Jul 1994)
PMID: 8066894, MUID: 94345886

 Digoxin Depletes Magnesium

1991 - Digoxin decreases magnesium in the cells and causes a lot of magnesium loss through the urine. Magnesium levels that are too low caused by diuretic use are very common in people also taking digoxin. Since low magnesium levels can lead to digoxin levels that are too high, both levels should be carefully watched - magnesium and digoxin.
     Not only does a low magnesium level contribute to heart arrhythmias, it causes increased sensitivity to digoxin. Low magnesium also interferes with digoxin's ability to control atrial fibrillation.
 
Sources:
Toffaletti J. Analyt Chem 1991 63(12):192R-194R
al-Ghamdi SM, et al. Am J Kidney Dis 1994 Nov;24(5):737-752
Young IS, et al. Br J Clin Pharmacol. 1991 Dec;32(6):717-721
Lewis R, et al. Br J Clin Pharmacol. 1991 Feb;31(2):200-203.)

 IV Magnesium For Arrhythmia

September 18, 1997 - Low magnesium levels are common in bypass surgery patients and are a risk factor for heart arrhythmia. IV magnesium avoids the side effects of most other drugs and reduces heart rate. The effects of IV magnesium are seen in patients with low magnesium and in those with normal magnesium levels, suggesting that magnesium has a drug-like action.
     Magnesium used alone is better than digoxin for controlling ventricular response in a-fib; the two together control heart rate better still. Magnesium is as effective as IV amiodarone in controlling heart rate and it may be better for cardioversion in atrial tachyarrhythmias. IV magnesium has been reported to successfully cardiovert atrial arrhythmia.
     There is evidence for using magnesium to prevent atrial arrhythmia after bypass surgery. Dr. Fanning studied a-fib in a trial with 99 patients, and patients receiving magnesium did much better. When patients have new a-fib after bypass surgery, we first look for reversible causes and then use an IV dose of 12 mmol of magnesium over a one hour period, followed by another 60 mmol over a 24 hour period, before we use other anti-arrhythmic drugs.
 
Source: Letter to the Editor of the New England Journal of Medicine
Title: Magnesium to Fight Arrythmias After Cardiac Surgery
Authors: William J.C. Hobbs, Alan Fitchet, and Lawrence Cotter

 Magnesium For CHF

September, 1996 - Electrolyte balance is important to the heart's stability, especially in heart failure. Magnesium is hard to study because it is so hard to accurately measure a person's magnesium level. The magnesium level in your blood represents less than 1% of total body magnesium stores.
     Magnesium is important in several enzyme reactions necessary for your heart's stability and proper functioning. Low magnesium level is common and is related to complications of heart failure. Typical CHF therapy (digoxin, diuretics and ACE inhibitors) changes your body's magnesium balance.
     Magnesium supplements - both by pill and also in higher prescription doses for serious deficiency - improve blood flow and arrhythmias. Magnesium levels are almost never toxic unless the patient has very poor kidney function.
     Proper magnesium levels in heart cells are crucial in maintaining stable heart and electrical function. In heart failure patients, proper magnesium level indicates a better prognosis because they relieve arrhythmias, digitalis poisoning and blood flow problems.
 
Title: Significance of magnesium in congestive heart failure.
Authors: Douban S, Brodsky MA, Whang DD, Whang R
Source: Am Heart J 1996 Sep;132(3):664-671
PMID: 8800040, UI: 96393253

 Low Magnesium and EF

September, 1997 - To see if low magnesium levels contribute to arrhythmias, we measured tissue magnesium levels (among other things) in 40 patients with arrhythmias. Magnesium was measured in sublingual tissue via x-ray. Patients with an EF over 40% had much higher tissue magnesium levels than patients with lower EFs.
     Low tissue magnesium levels may indicate high risk for certain arrhythmias, especially in patients with poor left ventricular function. However, moderately low magnesium levels may not matter to those with monomorphic ventricular tachycardia.
 
Title: Tissue magnesium levels and the arrhythmic substrate in humans.
Authors: Haigney MC, Berger R, Schulman S, Gerstenblith G, Tunin C, Silver B, Silverman HS, Tomaselli G, Calkins H
Source: J Cardiovasc Electrophysiol 1997 Sep;8(9):980-986
PMID: 9300294, UI: 97445409

 Low Magnesium and EF

August 30, 1999 - Low levels of magnesium in the blood are linked to higher risk of death from ischemic heart disease. Using 19 years of data from the National Health and Nutrition Examination Survey, Dr. Earl Ford analyzed ischemic heart disease deaths in over 12,000 people. He also studied all-cause mortality in 13,000 people. In the 2 groups combined, the number who were hospitalized for ischemic heart disease was 2,637 and the number of patients who died of ischemic heart disease was 1,005.
     Dr. Ford found that "low blood magnesium level - independent of other factors - was associated with all-cause mortality and death from ischemic heart disease." People with proper blood magnesium levels "had 21% to 34% less risk of dying from ischemic heart disease." About 23% of patients had too-low levels.
     The recommended dietary allowance of magnesium is 350mg for men and 280mg for women, but according to the results of the National Health Survey II, from 1988-1991 the average daily magnesium intake was too low.
 
Source: Int J Epidemiol 1999;28:645-651

 IV Magnesium, CHF and Arrhythmia

June, 1993 - Intravenous magnesium is an effective treatment for certain ventricular tachycardias. In patients with congestive heart failure, low blood magnesium levels are commonly seen in frequent arrhythmias with high death rates. This suggests that giving magnesium may lower the risk of arrhythmia and death in CHF patients.
     We studied the effect of IV magnesium on the frequency of ventricular premature depolarizations in 40 CHF patients. These patients were heart class 2 to class 4. Each patient had a 6-hour EKG recorded while engaging in normal activities. The study started within one week of the EKGs. Over a one-hour period, 0.2 mEq/kg of IV magnesium was given. A repeat EKG was then done.
     In patients for whom IV magnesium greatly increased their blood magnesium levels, arrhythmias went way down. In patients for whom the IV magnesium caused only a slight increase in blood magnesium levels, arrhythmias were slightly more frequent. In patients who had high arrhythmia levels before the magnesium, treatment reduced their arrhythmia rate by 50%. Overall, there was a 20% decrease of arrhythmias in all patients.
 
Title: Effects of intravenous magnesium sulfate on arrhythmias in patients with congestive heart failure.
Author: Gottlieb SS, Fisher ML, Pressel MD, Patten RD, Weinberg M, Greenberg N
Source: Am Heart J 1993 Jun;125(6):1645-1650
PMID: 8498307, UI: 93269785

 IV Magnesium and Arrhythmia In CHF

February, 1994 - There is a high rate of ventricular arrhythmia and sudden death in patients with heart failure. We studied the immediate effect of IV magnesium chloride on the frequency and severity of arrhythmia in 30 CHF patients. This was a double-blind, placebo-controlled crossover study. The average EF was 23%. No patient had a history of severe arrhythmia and none were taking anti-arrhythmic drugs, calcium channel blockers or beta-blockers.
     Patients took either placebo or 0.3 mEq/kg magnesium chloride, given intravenously over 10 minutes, followed by a another IV treatment of 0.08 mEq/kg per hour for 24 hours. Magnesium levels were measured 30 minutes and 24 hours after therapy began.
     Compared to placebo, IV magnesium reduced heart rhythym abnormalities per hour by about 50%. It also reduced episodes of ventricular tachycardia per day by about 65%. Intravenous magnesium chloride use reduces the frequency of arrhythmia in CHF patients.
 
Title: Effect of acute magnesium administration on the frequency of ventricular arrhythmia in patients with heart failure.
Author: Sueta CA, Clarke SW, Dunlap SH, Jensen L, Blauwet MB, Koch G, Patterson JH, Adams KF Jr
Source: Circulation 1994 Feb;89(2):660-666
PMID: 7508827, UI: 94147599

 IV Magnesium and Angina

January 5, 2001 - In patients with angina caused by blood vessel spasms, IV magnesium expands the coronary arteries and reduces those spasm, according to a new report.
     In 22 patients with vasospastic angina, Dr. Hiroki Teragawa caused such spasms with acetylcholine. In 14 patients - after the spasm had spontaneously stopped - researchers gave IV magnesium sulfate at 0.27 mmol/kg of body weight over 20 minutes. As a control, the other 8 patients received IV placebo (isotonic glucose).
     Dr. Teragawa then induced another coronary spasm in the patients and measured the diameter of their coronary arteries. Magnesium dilated the entire coronary artery. During spasm, the severity of chest pain and EKG abnormalities were reduced in the magnesium group. The diameter of the spastic arteries improved from an aveage -63% to -44% during coronary spasm in the patients taking magnesium. Overall, 71% of the magnesium patients responded favorably.
     Among control patients during coronary spasm, there were no changes in severity of chest pain, EKG abnormalities, or diameter of the coronary arteries. "These findings suggest that IV magnesium may have a therapeutic use in patients with ischemic heart disease associated with coronary spasm. Long-term oral magnesium supplements might prevent or reduce coronary spasm in patients with this type of angina," Dr. Teragawa concluded.
 
Source: Chest 2000;118:1690-1695

 IV Magnesium and A-fib

January 31, 2001 - Risk of atrial fibrillation - a common complication of CABG - is reduced when magnesium is given.
     Dr. Huseyin Alhan studied magnesium's ability to prevent a-fib after bypass surgery. He gave 200 patients having bypass either 1.5 grams of IV magnesium or just a saline solution alone; one day before, during, and 4 days after surgery.
     Only 2% of magnesium-treated patients had a-fib after surgery, while 21% of untreated patients had a-fib. "Many studies have shown that magnesium has an effect on a-fib, but the proper dose and when to give it remained unclear," Dr. Alhan said. "We give this therapy to patients with normal as well as low magnesium levels," he stated.
     "In the elderly it has been shown that patients may be completely deficient in magnesium but still test normal on blood tests," Dr. Alhan explained. "We are not sure if the benefit is from replenishing a deficiency or if it is just an effect of magnesium."
     "Atrial fibrillation is not the most serious complication after heart surgery but it is the most common," Dr. Alhan pointed out. "It has a strong impact on the hospital length of stay and therefore on the cost of heart surgery. The patients who received magnesium in this study went home earlier."
 
From: The 37th annual meeting of The Society of Thoracic Surgeons
Source: Reuters Health

 Electrolyte Levels and CHF

1994 - Thiazides and loop diuretics cause potassium and magnesium loss through the kidneys, which leads to deficiencies that require supplements. These losses may be overlooked because blood levels of both electrolytes may remain normal even when the muscle concentrations are far too low.
     We tested 76 patients who had taken diuretics for 1 to 17 years. The average levels K (potasium), MG (magnesium) and niacin "pumps" in skeletal muscle biopsies were greatly lower in these patients than in the biopsies from a healthy control group. Magnesium and potassium levels were related: if one was low, the other was low.
     The blood levels though, were only low in a few patients. The fact that MG and K deficiencies are often overlooked shows the need for checking skeletal muscle. A simple biopsy needle procedure detects electrolyte problems even if blood levels seem okay. With this technique we detected build-up of the muscle electrolytes after a MG supplementation period. Oral magnesium supplements can re-establish normal MG as well as potassium levels in patients on long-term diuretic therapy, provided that supplements are taken for 6 months. Restoring muscle MG and K was linked to a restored Niacin level.
 
Title: Magnesium and potassium deficiency. Its diagnosis, occurrence and treatment in diuretic therapy and its consequences for growth, protein synthesis and growth factors
Author: Dorup I
Source: Acta Physiol Scand Suppl 1994;618:1-55
PMID: 8036903, UI: 94310918

 Hyperkalemia - Too Much Potassium

July, 1990 - Eight patients with life threatening hyperkalemia (too-high potassium levels) were treated in the intensive care unit over a period of 2 years. Blood potassium level at admission was 7.1 to 11.2. Two patients had to be resuscitated and 3 had severe temporary paralysis. Seven showed considerable EKG change: the atrial wave was absent in all 7 patients. Kidney failure was seen in 7 of 8 patients. In 6 of these 8 patients, drugs were involved in the development of hyperkalemia. The following treatment is recommended for too-high potassium level:

  1. injecting calcium
  2. inhaling or injecting beta 2-mimetics
  3. insulin and glucose by IV
  4. sodium bicarbonate, but only in case of metabolic acidosis
  5. dialysis
  6. cation exchange resins or Lasix in non-acute situations

Title: Hyperkalemic emergency: causes, diagnosis and therapy
Author: Tamm M, Ritz R, Thiel G, Truniger B
Source: Schweiz Med Wochenschr 1990 Jul 21;120(29):1031-1036
PMID: 2374893, UI: 90327017


All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Jon C.

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