Magnesium balance and its disorders

Magnesium (Mg) is an essential mineral that participates in more than 300 enzyme reactions and also plays an important role as a second messenger.[i] It stabilizes the resting membrane potential of muscle and nerve cells[ii] and as such plays a critical role in neuromuscular conduction, cardiac excitability and vasomotor tone.[iii] In addition, a role for Mg in insulin resistance has been advocated.[iv]

In line with these actions are reports that hypomagnesemia may be associated with increased incidence of migraine, [v] Alzheimer´s disease,[vi] coronary heart disease, hypertension,[vii] diabetes mellitus type 2. A well studied important role has been established for magnesium in pre-eclampsia and eclampsia.[viii] However, although oral magnesium sulfate administration is now an acknowledged therapeutic measure in this patient group, concerns remain about toxicity and would therefore make pregnant women a particularly well suited group for screening and monitoring of Mg status. Hypomagnesiuria has also been described in up to 60% of patients with urolithiasis;[ix] Mg substitution and control is therefore important in this disease group.

Clinically useful Mg status screening and monitoring  using  the uMg/uCrea ratio in spot urine samples should therefore be helpful in in the following patient groups:

Mg-PoCT Market potential focused “only” on patients with high medical need

Mg depletion (MgD) and Mg overload (MgO) focus groups:

(1) The majority of 6 million cases/year of pre-eclampsia worldwide is treated with Mg-sulfate
(2) 5% of the population worldwide have kidney stones, of which 50% have hypomagnesiuria [x]
(3) Prevalence of migraine 15% worldwide [xi]

[i] Li FY, Chaigne-Delalande B, Kanellopoulo C, Davis JC, Matthews F, Douek DC, Cohen JI, Uzel G, SU HC, Leonardo MJ. Second messenger role for Mg2+ revealed by human T-cell immunodeficiency. Nature 475:471-6(2011)

[ii] Saris NE, Mervaala J, Karpanen H, Khawaja JA, Lewenstam A. Magnesium. An update on physiological clinical and analytical aspects. Clin Chim Acta 294:1-26(2000)

[iii] Volpe SL. Magnesium in disease prevention and overall health. Adv Nutr 4:378S-83S(2013)

[iv] Takaya J, Higashino H, Kobayashi Y. Intracellular magnesium and insulin resistance. Magnes Res 17:126-36(2004)

[v] Pringsheim T, Davenport W, Mackie G, Worthington I, Aube M, Christie SM, Gladstone J, Becker WJ: Canadian Headache Society Guideline for Migraine Prophylaxis. Can J Neurol Sci 39:S1-S9(2012)

[vi] Barbagallo M, Belvedere M, Di Bella G, Dominguez LJ. Altered ionized magnesium levels in mild-to-moderate Alzeheimer´s disease. Magnes Res 24:S115-21(2011)

[vii] a) Wu J, Xun P, Tang Q, Cai W, He K. Circulating magnesium levels and incidence of coronary heart disease, hypertension and type 2 diabetes mellitus: a meta-analysis of prospective cohort studies. Nutr J 16:1-13(2017); b) Barbagallo M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes 6:1152-7(2015)

[viii] Gordon A, Magee LA, Payne B, Firoz T, Sawtchuk D, Tu D, Vidler M, de Silva D, Dadelszen P. Magnesium sulphate for the management of preeclampsia and eclampsia in middle and low-income countries: a systematic review of dosing regimens. J Obstet Gynecol Can 36:154-63(2014)

[ix] Menditto VG, Lucci M, Polonara S. The role of hypomagnesuria in urolithiasis and renal colic: results from a prospective study of a metabolic protocol. Minaerva Med 103:377-82(2012)

[x] Bartoletti R, Cai T, Mondiani N, Travaglini F, Carini M, Rizzo M. Epidemiology and risk factors in urolithiasis

[xi] World Health Organization. Headache Disorders. Fact Sheet #277 (http://www.who.int/mediacentre/factsheets/fs277/en/)