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[Subcutaneous magnesium pump in a patient with combined magnesium transport defect]
P M Aries1, M Schubert, D Müller-Wieland
1Klinik II und Poliklinik für Innere Medizin, Universität Köln. PMAries@aol.com
History And Admission Findings:
A 28-year-old man, known to have abnormal intestinal magnesium absorption, presented with recurrent cerebral seizures. Despite daily intravenous sulphate infusions, magnesium concentration remained inadequate. Physical examination was unremarkable.
Investigations:
Serum magnesium concentration was markedly reduced to 0.48 mmol/l. The parenteral magnesium tolerance test indicated reduced enteric magnesium absorption of < 20%. Absolute magnesium concentration in 24-hour urine was normal at 6.3 mmol/24 h, but high in proportion to the hypomagnesaemia. All other laboratory data were within normal limits.
Treatment And Course:
In addition to the known intestinal malabsorption the patient also had isolated renal loss of magnesium. It was only by continuous magnesium infusion with a recently developed portable subcutaneous pump system that normal serum magnesium concentrations were attained and all symptoms disappeared.
Conclusion:
This patient has combined magnesium transport defects, which could not be effectively treated by conventional methods, but required continuous magnesium infusion with an indwelling subcutaneous infusion pump. This case serves as an example of the way in which subcutaneous infusion can provide physiological substitution of electrolytes.
