Mike Carnes, D.O., F.A.A.O.

University of Pikeville
Kentucky College of Osteopathic Medicine

 N-methyl-D-aspartate (NMDA) receptors

Ca2+ channel that is blocked physiologically by Mg2+
Methadone is unique amongst the narcotics
Zinc also can block these receptors

Neuropathic pain
Neuronal damage
Acute excitotoxic activity and oxidative stress with rapid

Ca2+ influx
Delayed signaling leading to cell apoptosis is a problem
when the receptors are blocked pharmacologically
Searching for a pathologically activated NMDA receptor
antagonist

 Mitochondrial ATP production

Cofactor in thiamine dependent reactions
Cofactor in Na+ K+ ATPase activity

K+ secretion block (deficiency of Mg2+

low K+)
Can inhibit acetylcholine release (myasthenia gravis)
Deficiency may lead to hypocalcemia 20 to effect on PTH
secretion
Aerobic metabolism, anaerobic metabolism, glycolysis,
oxidative phosphorylation
Cofactor in some 300 enzymatic reactions
Low Mg2+ & vitamin D (and some other micronutrients)
can contribute to accelerated aging and adverse
outcomes

 Adult 25 grams
Bone 50%
25% of the total body Mg2+ insoluble mineral phase

99% of extraskeletal Mg2+ is intracellular

Less than 1% of total body magnesium is in ECF

Serum concentrations are closely regulated by the body

30% protein bound
15% loosely complexed to phosphate and other anions

Serum level below 1.8 mg/dL is indicative of total body

magnesium deficit

 Nuts, unpolished grains, green leafy vegetables, halibut

Meats, lentils, starches, milk
Absorbed in distal jejunum and ilium (30 40%)
1, 25-(OH)2D can stimulate this to reach 70% in times of

magnesium depletion
Low protein diets (less than 30 grams/day) decreases
magnesium absorption
RDA
Women 360 mg/d (14-18) tapers to 320 mg/d
Men 420 mg/d gradually increasing with age

60 % of US population does not get their RDA

Excreted by nephron in the loop of Henle

 Extremely rare in the absence of renal dysfunction

% absorbed inversely related to amount ingested
Renal function may worsen with supplementation
Tetanus therapeutic dose may also effect diaphragm

4.8 mg/dL - hypotension, neuromuscular blockade

9 mg/dL - loss of DTRs, respiratory suppression, nausea,

lethargy
20 mg/dL asystole

 Neuropathic pain
Migraines/headache, Bruxism, Nocturnal muscle cramp
Chronic Fatigue Syndrome / Fibromyalgia
Sickle crisis / anemia (pain, RBC dehydration, vascular

adhesion)
Dysmenorrhea
Post-operative pain
Ischemic stroke
Asthma
Acute nebulized or IV
Chronic oral

Cardiac arrhythmias (particularly QT prolongation)

 Oral increase by one tab every 3 4 days to bowel

tolerance, then decrease by one tab

Topical MgCl 20% cream
Epsom Salt soak (MgCl)
Parenteral for pain or spasm with intact renal function
4 gram dose intraoperatively
1 1.5 grams per hour
Scale
2.4 2.5 mg/dL = 1 gram mag sulfate in 50 cc NS
2.2 2.3 mg/dL = 2 grams mag sulfate in 100 cc NS
2.0 2.1 mg/dL = 3 grams mag sulfate in 150 cc NS
1.8 1.9 mg/dL = 4 grams mag sulfate in 250 cc NS
1.6 1.7 mg/dL = 6 grams mag sulfate in 250 cc NS
1.5 or below = 8 grams mag sulfate in 500 cc NS

 Harrison's Principles of Internal Medicine, 18th Edition.

McGraw-Hill Professional Publishing, 07/2011.

Present Knowledge in Nutrition, 10th Edition., John Wiley
& Sons, Inc., 2012