Related Experiment Videos
Hypomagnesemia and concurrent acid-base and electrolyte abnormalities in patients with congestive heart failure
Haralampos J Milionis1, George E Alexandrides, Evangelos N Liberopoulos
1Department of Internal Medicine, Medical School University of Ioannina, GR 45110, Ioannina, Greece.
Insights
Magnesium deficiency is common in severe congestive heart failure (CHF) patients, affecting 17.4%. Early detection and treatment of hypomagnesemia are crucial to prevent dangerous heart rhythm problems.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Severe congestive heart failure (CHF) often presents with electrolyte imbalances due to neurohumoral activation and medications.
- Magnesium deficiency (hypomagnesemia) is frequently observed in CHF patients, yet its pathophysiology is less understood than other electrolyte disturbances.
- Addressing hypomagnesemia may prevent adverse cardiac events, particularly arrhythmias.
Purpose of the Study:
- To determine the incidence of magnesium level disorders in patients with CHF.
- To investigate the underlying pathophysiological mechanisms contributing to magnesium imbalances in this population.
Main Methods:
- Studied 86 consecutive CHF patients (NYHA class III-IV) over 5 years, excluding those with diabetes, liver/renal failure, or COPD.
- Administered standard CHF treatments including digoxin, diuretics, and ACE inhibitors.
- Assessed blood and urine electrolytes, renal function, arterial blood gases, and serum anion gap on admission.
Main Results:
- Hypomagnesemia was identified in 15 patients (17.4%).
- Most hypomagnesemic patients also had other electrolyte abnormalities like hypokalemia, hypocalcemia, and hypophosphatemia.
- Inappropriate urinary magnesium excretion (fractional excretion >4%) was noted in eight patients, suggesting renal loss, alongside factors like poor diet contributing to depletion.
Conclusions:
- Magnesium deficit is a prevalent electrolyte disorder in severe CHF (NYHA class III/IV).
- Multiple interconnected mechanisms contribute to the pathogenesis of hypomagnesemia in CHF.
- Increased clinician awareness of hypomagnesemia incidence and pathophysiology in CHF is vital for early detection and treatment, mitigating arrhythmogenic risks.
Background:
Patients with severe decompensated congestive heart failure (CHF) commonly exhibit acid-base and electrolyte disturbances mainly due to the activation of several neurohumoral mechanisms as well as to drugs regularly used in this population. Magnesium deficit is not infrequently observed in CHF patients but its pathophysiology remains less well-studied as compared with other electrolyte alterations, such as hypokalemia. However, there is evidence that early detection and correction of magnesium abnormalities could obviate potentially deleterious arrhythmogenic effects.
Aim:
To assess the incidence of magnesium level disorders and analyze the underlying pathophysiological mechanisms in patients with CHF.
Methods:
Eighty-six consecutive CHF patients (NYHA class III or IV) admitted to our hospital over a period of 5 years were studied. Patients with diabetes mellitus, liver or renal failure, and chronic obstructive lung disease were excluded. All patients received conventional treatment with digoxin, diuretic agents and an angiotensin converting enzyme inhibitor. On admission, blood and urine electrolytes and renal function parameters were determined. Arterial blood gases and serum anion gap determinations were also performed.
Results:
Hypomagnesemia was found in 15 [n=15 (17.4%)] CHF patients. The majority of these patients also exhibited other electrolyte abnormalities, such as hypokalemia, hypocalcemia and hypophosphatemia. Inappropriate magnesiuria (fractional excretion of magnesium >4%) was evident in eight hypomagnesemic patients. A variety of associated conditions, including poor dietary intake, also favored magnesium depletion.
Conclusion:
Magnesium deficit is a common electrolyte disorder in CHF (NYHA class III/IV) patients and several interrelated mechanisms are implicated in its pathogenesis. Clinicians' awareness of the incidence of hypomagnesemia in this population as well as its related pathophysiology could be useful for the early detection and appropriate treatment to inhibit its arrhythmogenic potential.