DOCSLIB.ORG

Evidence for Suppression of Parathyroid Gland Activity by Hypermagnesemia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evidence for Suppression of Parathyroid Gland Activity by Hypermagnesemia Evidence for suppression of parathyroid gland activity by hypermagnesemia Shaul G. Massry, … , Jack W. Coburn, Charles R. Kleeman J Clin Invest. 1970;49(9):1619-1629. https://doi.org/10.1172/JCI106379. Research Article The effect of hypermagnesemia, produced by MgCl2 infusion, on the activity of parathyroid glands, as assessed by changes in levels of serum calcium (SCa) and in the fraction of filtered phosphate excreted (CP/CCr), was studied in 11 intact and 4 thyroparathyroidectomized (T-PTX) dogs. To exclude the effect of diurnal variation in CP/CCr on the results, studies were initiated in both morning and afternoon hours and each study with MgCl2 infusion was paired with a control experiment in the same dog not receiving MgCl2. During MgCl2 infusion, serum phosphorus rose progressively. Despite this rise, the levels of CP/CCr fell in all experiments and were significantly different from values observed at the same time of the day in the paired control experiments. The concentrations of total SCa fell by 1.0-2.4 mg/100 ml with a proportional decrease in the levels of the diffusible and ionized fractions. The pattern of the fall in CP/CCr during MgCl2 resembled that observed after CaCl2 infusion (seven dogs) and that which acutely followed thyroparathyroidectomy (seven dogs). When parathyroid extract was given to dogs receiving MgCl2 infusion both CP/CCr and SCa rose, and MgCl2 infusion did not affect CP/CCr and SCa in T-PTX dogs. These results indicate that hypermagnesemia suppresses the activity of the parathyroid glands, probably, by inhibiting production and (or) release of the hormone, without interfering with […] Find the latest version: https://jci.me/106379/pdf Evidence for Suppression of Parathyroid Gland Activity by Hypermagnesemia SHAuL G. MASSRY, JACK W. COBURN, and CHARLEs R. KLEEMAN From Cedars-Sinai Medical Research Institute and the Departments of Medicine, Cedars-Sinai Medical Center, Veterans Administration Center, and the University of California at Los Angeles School of Medicine, Los Angeles, California 90048 A B S T R A C T The effect of hypermagnesemia, pro- of simultaneous modest hypocalcemia and hypermag- duced by MgCla infusion, on the activity of parathyroid nesemia suggests that a decrease in the level of serum glands, as assessed by changes in levels of serum cal- calcium is more potent than an increase in the concen- cium (Sca) and in the fraction of filtered phosphate tration of serum magnesium in the regulation of para- excreted (CP/Ccr), was studied in 11 intact and thyroid activity. 4 thyroparathyroidectomized (T-PTX) dogs. To ex- clude the effect of diurnal variation in CP/Ccr on the re- sults, studies were initiated in both morning and after- INTRODUCTION noon hours and each study with MgCL infusion was Although it is well documented that the concentration paired with a control experiment in the same dog not of ionized calcium in the plasma is of primary impor- receiving MgCl2. During MgCL infusion, serum phos- tance in regulating parathyroid hormone secretion (1- phorus rose progressively. Despite this rise, the levels 3), evidence exists suggesting that the level of blood of CP/Ccr fell in all experiments and were significantly magnesium may also play a role in the regulation of the different from values observed at the same time of the activity of the parathyroid glands. In the rat, magnesium day in the paired control experiments. The concentra- deficiency and hypomagnesemia may stimulate the para- tions of total Sca fell by 1.0-2.4 mg/100 ml with a pro- thyroid glands (4-6). Gitelman, Kukolj, and Welt portional decrease in the levels of the diffusible and (7) reported data in nephrectomized rats compatible ionized fractions. The pattern of the fall in CP/Cc, with the concept that hypermagnesemia may suppress the during MgCl2 resembled that observed after CaClh in- activity of the parathyroid glands in the rat; their stud- fusion (seven dogs) and that which acutely followed ies, however, do not exclude the possibility that the hy- thyroparathyroidectomy (seven dogs). When parathy- pocalcemic effect of magnesium injections could have roid extract was given to dogs receiving MgCla infu- been produced by mechanism(s) other than the inhibi- sion both CP/CCr and Sc. rose, and MgClh infusion did tion of the parathyroid glands. In four experiments not affect CP/Ccr and Sc. in T-PTX dogs. These results utilizing the in vivo perfusion of isolated parathyroid indicate that hypermagnesemia suppresses the activity glands in goats and sheep with perfusate containing high of the parathyroid glands, probably, by inhibiting pro- concentration of magnesium, there was an inverse cor- duction and (or) release of the hormone, without inter- relation between the level of parathyroid hormone in the fering with end-organ response. An increase in serum affluent blood and the concentration of magnesium in magnesium of 1.7-2.0 mg/100 ml was capable of pro- the perfusate in three experiments; this correlation was ducing the suppressive effect. Evaluation of the effect highly significant in only one study (8). The relation between magnesium metabolism and the This work was presented in part before the Western Sec- activity of parathyroid glands in the dog and man has tion of the American Federation for Clinical Research, not been delineated. Magnesium deficiency in the dog Carmel, Calif., 2 February 1968. may be associated with normal or low levels of serum Dr. Massry is an Established Investigator of the American the effect of acute Heart Association. calcium (9-12); hypermagnesemia Received for publication 18 February 1970 and in revised on the activity of the parathyroid glands has not been form 23 April 1970. studied in the species. In man, magnesium deficiency The Journal of Clinical Investigation Volume 49 1970 1619 may be accompanied by hypocal- and hypomagnesemia CONTROL INFUSION ; -itott MgCI2 cemia (13), which cannot be corrected by the adminis- I M tration of parathyroid extract, suggesting that the skele- I I 0 a 0 5' ton is rendered resistant to the action of parathormone. V- _ and U The repeated injections of magnesium salts (14) utE oral magnesium loading (15) to humans were associated 0)J------- - with a decrease in phosphate excretion; these results Di 911 were not attributed to inhibition of parathyroid glands. 0 Furthermore, the relative importance of simultaneous gm.UE a changes in the concentration of serum calcium and mag- %A E 9L nesium in the regulation of the activity of parathyroid .E _ 6. glands is not known. 0 The present study was undertaken to evaluate the ef- fect of acute hypermagnesemia on the activity of the parathyroid glands in the dog as assessed by changes in the concentration of serum calcium and in the fraction T of filtered phosphate excreted. The influence of a simul- E4J0 UNO., ,.T-' -T. l-rlT-17 taneous hypermagnesemia and hypocalcemia on the ac- 10 tivity of these glands was also studied. Qz so 4: METHODS 52 experiments were carried out during pentobarbital anes- thesia in 18 intact and 11 thyroparathyroidectomized (T-PTX) mongrel dogs weighing 16-25 kg. An oral water TIME (p.m.) load of 500 ml was given to the animals in each experiment FIGURE 2 Afternoon studies. The changes in mean levels of serum magnesium (Mg), calcium (Ca), and phosphorus ( P) and in the fraction of filtered phosphate excreted CONTROL INFUSION 0 without MgC12 (Cp/Cc,) in four intact dogs with and without the infusion a E 10 of MgCl2 (100,ug Mg'+/kg per min). The changes in CP/Cc, 0 are expressed as in Fig. 1. Ut £L~- :1-~ - ZuE I hr before the induction of anesthesia. Respiration was controlled by a Harvard respiratory pump, which was adjusted initially with a stroke volume of 10 ml/kg body weight and at a rate of 30 strokes/min. Blood pH was mea- sured several times during each study with a Radiometer pH meter (London Co., Westlake, Ohio), and the stroke volume of the respirator was adjusted thereafter to maintain 150. blood pH within normal range; usually, little adjustment 0 was necessary. Glomerular filtration rate was measured by B.- .r1/ exogenous creatinine clearance. Urine was collected from w 100. a retention catheter, and the bladder was washed with air vO at the end of each period. Blood was obtained at the mid- V Z k.., point of each clearance period from an indwelling needle in 50. the femoral vein. The studies were ma I L I T . following performed. .0 _ Experiments zedth the infussion of magnesium chloride (15 dogs, 38 experiments). After three control clearance pe- O. T ---r- I" riods, each of 20 min duration, magnesium chloride was 10 11 12 1 2 3 4 5 added to 0.45%o saline, and this solution was infused at I ml/ a.m. TIME p.m. min for 6 hr to deliver 100 gug Mg'+/kg per min in each experiment unless noted otherwise; clearance collections of FIGURE 1 Morning studies. The changes in mean levels of 30 min duration were obtained throughout. To exclude the serum magnesium (Mg) and phosphorus (P) and in the effect of the diurnal variation in phosphate excretion on the fraction of filtered phosphate excreted (CP/CC,) in seven results, experiments were initiated in both morning (morn- intact dogs with and without the infusion of MgClz (100 ing studies) and afternoon (afternoon studies) hours, and Ag Mg'+/kg per min). In order to reduce the variability in each experiment with infusion of MgCl2 was paired with absolute fraction of CP/CCr from one experiment to another, a control study in which the same animal received only the changes in CP/Cc, are expressed as the per cent of the 0.4517o saline at 1 ml/min for 6 hr over the same period of mean of the three control clearances in each individual ex- the day during which the MgCl2 infusion was given.
Load more

Recommended publications
  • Dysmagnesemia in Covid-19 Cohort Patients: Prevalence and Associated Factors
    Magnesium Research 2020; 33 (4): 114-122 ORIGINAL ARTICLE Dysmagnesemia in Covid-19 cohort patients: prevalence and associated factors Didier Quilliot1, Olivier Bonsack1, Roland Jaussaud2, Andre´ Mazur3 1 Transversal Nutrition Unit and; 2 Internal Medicine and Clinical Immunology. Nancy University Hospital, University of Lorraine, France; 3 Universite´ Clermont Auvergne, INRAE, UNH, Unite´ de Nutrition Humaine, Clermont-Ferrand, France Correspondence <[email protected]> Abstract. Hypomagnesemia and hypermagnesemia could have serious implications and possibly lead to progress from a mild form to a severe outcome of Covid-19. Susceptibility of subjects with low magnesium status to develop and enhance this infection is possible. There is little data on the magnesium status of patients with Covid-19 with different degrees of severity. This study was conducted to evaluate prevalence of dysmagnesemia in a prospective Covid-19 cohort study according to the severity of the clinical manifestations and to identify factors associated. Serum magnesium was measured in 300 of 549 patients admitted to the hospital due to severe Covid-19. According to the WHO guidelines, patients were classified as moderate, severe, or critical. 48% patients had a magnesemia below 0.75 mmol/L (defined as magnesium deficiency) including 13% with a marked hypomagnesemia (<0.65 mmol/L). 9.6% had values equal to or higher than 0.95 mmol/L. Serum magnesium concentrations were significantly lower in female than in male (0.73 Æ 0.12 vs 0.80 Æ 0.13 mmol/L), whereas the sex ratio M/F was higher in severe and critical form (p<0.001). In a bivariate analysis, the risk of magnesium deficiency was significantly and negatively associated with infection severity (p<0.001), sex ratio (M/F, p<0.001), oxygenotherapy (p<0.001), stay in critical care unit (p=0.028), and positively with nephropathy (p=0.026).
    [Show full text]
  • Magnesium: the Forgotten Electrolyte—A Review on Hypomagnesemia
    medical sciences Review Magnesium: The Forgotten Electrolyte—A Review on Hypomagnesemia Faheemuddin Ahmed 1,* and Abdul Mohammed 2 1 OSF Saint Anthony Medical Center, 5666 E State St, Rockford, IL 61108, USA 2 Advocate Illinois Masonic Medical Center, 833 W Wellington Ave, Chicago, IL 60657, USA; [email protected] * Correspondence: [email protected] Received: 20 February 2019; Accepted: 2 April 2019; Published: 4 April 2019 Abstract: Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It plays an important role in different organ systems at the cellular and enzymatic levels. Despite its importance, it still has not received the needed attention either in the medical literature or in clinical practice in comparison to other electrolytes like sodium, potassium, and calcium. Hypomagnesemia can lead to many clinical manifestations with some being life-threatening. The reported incidence is less likely than expected in the general population. We present a comprehensive review of different aspects of magnesium physiology and hypomagnesemia which can help clinicians in understanding, identifying, and treating this disorder. Keywords: magnesium; proton pump inhibitors; diuretics; hypomagnesemia 1. Introduction Magnesium is one of the most abundant cation in the body as well as an abundant intracellular cation. It plays an important role in molecular, biochemical, physiological, and pharmacological functions in the body. The importance of magnesium is well known, but still it is the forgotten electrolyte. The reason for it not getting the needed attention is because of rare symptomatology until levels are really low and also because of a lack of proper understanding of magnesium physiology.
    [Show full text]
  • Novel Mutations Associated with Inherited Human Calcium-Sensing
    1 180 A García-Castaño, Novel mutations in the calcium 180:1 59–70 Clinical Study L Madariaga and others receptor gene Novel mutations associated with inherited human calcium-sensing receptor disorders: A clinical genetic study Alejandro García-Castaño1,*, Leire Madariaga1,2,*, Gustavo Pérez de Nanclares1,2, Gema Ariceta3, Sonia Gaztambide1,2 and Luis Castaño1,2 on behalf of Spanish Endocrinology Group and Renal Tube Group Correspondence should be addressed 1Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain, 2Hospital Universitario Cruces, to L Castaño UPV/EHU, Barakaldo, Spain, and 3Hospital Universitario Materno-Infantil Vall d’Hebron, Autonomous University of Email Barcelona, Barcelona, Spain LUISANTONIO. *(A García-Castaño and L Madariaga contributed equally to this work) CASTANOGONZALEZ@ osakidetza.eus Abstract Objective: Molecular diagnosis is a useful diagnostic tool in calcium metabolism disorders. The calcium-sensing receptor (CaSR) is known to play a central role in the regulation of extracellular calcium homeostasis. We performed clinical, biochemical and genetic characterization of sequence anomalies in this receptor in a cohort of 130 individuals from 82 families with suspected alterations in the CASR gene, one of the largest series described. Methods: The CASR gene was screened for mutations by polymerase chain reaction followed by direct Sanger sequencing. Results: Presumed CaSR-inactivating mutations were found in 65 patients from 26 families. These patients had hypercalcemia (median: 11.3 mg/dL) but normal or abnormally high parathyroid hormone (PTH) levels (median: 52 pg/ mL). On the other hand, presumed CaSR-activating mutations were detected in 17 patients from eight families. These patients had a median serum calcium level of 7.4 mg/dL and hypoparathyroidism (median: PTH 13 pg/mL).
    [Show full text]
  • Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness
    Original Investigation Increased Mortality Associated with Hypermagnesemia in Severe COVID-19 Illness Jacob S. Stevens 1,2, Andrew A. Moses1, Thomas L. Nickolas1,2, Syed Ali Husain1,2, and Sumit Mohan1,2,3 Key Points Hypermagnesemia is common in patients admitted with coronavirus disease 2019. The development of hypermagnesemia in coronavirus disease 2019 is associated with renal failure and markers of high cell turnover. In adjusted models, patients who develop hypermagnesemia have an increased risk of mortality. Abstract Background Although electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia, and its association with outcomes among patients admitted with COVID-19. Methods We retrospectively identified all patients with a positive test result for SARS-CoV-2who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients’ demographics and hospital course were obtained retrospectively from medical records. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was .2.4 mg/dl. Results A total of 1685 patients hospitalized with COVID-19 had their magnesium levels checked during their hospitalization, and were included in the final study cohort, among whom 355 (21%) had hypermagnesemia. Patients who were hypermagnesemic had a higher incidence of shock requiring pressors (35% vs 27%, P,0.01), respiratory failure requiring mechanical ventilation (28% vs 21%, P50.01), AKI (65% vs 50%, P,0.001), and AKI severe enough to require renal replacement therapy (18% vs 5%, P,0.001).
    [Show full text]
  • Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside Or Colistin Therapy: a Systematic Review
    antibiotics Review Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside or Colistin Therapy: A Systematic Review Martin Scoglio 1,* , Gabriel Bronz 1, Pietro O. Rinoldi 1,2, Pietro B. Faré 3,Céline Betti 1,2, Mario G. Bianchetti 1, Giacomo D. Simonetti 1,2, Viola Gennaro 1, Samuele Renzi 4, Sebastiano A. G. Lava 5 and Gregorio P. Milani 2,6,7 1 Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; [email protected] (G.B.); [email protected] (P.O.R.); [email protected] (C.B.); [email protected] (M.G.B.); [email protected] (G.D.S.); [email protected] (V.G.) 2 Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; [email protected] 3 Department of Internal Medicine, Ospedale La Carità, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland; [email protected] 4 Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; [email protected] 5 Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland; [email protected] 6 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy 7 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy * Correspondence: [email protected] Citation: Scoglio, M.; Bronz, G.; Abstract: Aminoglycoside or colistin therapy may alter the renal tubular function without decreasing Rinoldi, P.O.; Faré, P.B.; Betti, C.; the glomerular filtration rate. This association has never been extensively investigated.
    [Show full text]
  • Early-Onset Neonatal Hyperkalemia Associated with Maternal
    Tanaka et al. BMC Pediatrics (2018) 18:55 https://doi.org/10.1186/s12887-018-1048-4 CASEREPORT Open Access Early-onset neonatal hyperkalemia associated with maternal hypermagnesemia: a case report Kenichi Tanaka1, Hiroko Mori1, Rieko Sakamoto2, Shirou Matsumoto2, Hiroshi Mitsubuchi1, Kimitoshi Nakamura2 and Masanori Iwai1* Abstract Background: Neonatal nonoliguric hyperkalemia (NOHK) is a metabolic abnormality that occurs in extremely premature neonates at approximately 24 h after birth and is mainly due to the immature functioning of the sodium (Na+)/potassium (K+) pump. Magnesium sulfate is frequently used in obstetrical practice to prevent preterm labor and to treat preeclampsia; this medication can also cause hypermagnesemia and hyperkalemia by a mechanism that is different from that of NOHK. Herein, we report the first case of very early-onset neonatal hyperkalemia induced by maternal hypermagnesemia. Case presentation: A neonate born at 32 weeks of gestation developed hyperkalemia (K+ 6.4 mmol/L) 2 h after birth. The neonate’s blood potassium concentration reached 7.0 mmol/L 4 h after birth, despite good urine output. The neonate and his mother had severe hypermagnesemia caused by intravenous infusion of magnesium sulfate given for tocolysis due to pre-term labor. Conclusion: The early-onset hyperkalemia may have been caused by the accumulation of potassium ions transported through the placenta, the shift of potassium ions from the intracellular to the extracellular space in the infant due to the malfunctioning of the Na+/K+ pump and the inhibition of renal distal tube potassium ion secretion, there is a possibility that these mechanisms were induced by maternal and fetal hypermagnesemia after maternal magnesium sulfate administration.
    [Show full text]
  • Electrolyte Disorders and Arrhythmogenesis
    Cardiology Journal 2011, Vol. 18, No. 3, pp. 233–245 Copyright © 2011 Via Medica REVIEW ARTICLE ISSN 1897–5593 Electrolyte disorders and arrhythmogenesis Nabil El-Sherif1, Gioia Turitto2 1State University of NY, Downstate Medical Center and NY Harbor VA Healthcare System, Brooklyn, NY, USA 2Methodist University Hospital, Brooklyn, NY, USA Abstract Electrolyte disorders can alter cardiac ionic currents kinetics and depending on the changes can promote proarrhythmic or antiarrhythmic effects. The present report reviews the mecha- nisms, electrophysiolgical (EP), electrocardiographic (ECG), and clinical consequences of elec- trolyte disorders. Potassium (K+) is the most abundent intracellular cation and hypokalemia is the most commont electrolyte abnormality encountered in clinical practice. The most signifcant ECG manifestation of hypokalemia is a prominent U wave. Several cardiac and + non cardiac drugs are known to suppress the HERG K channel and hence the IK, and especially in the presence of hypokalemia, can result in prolonged action potential duration and QT interval, QTU alternans, early afterdepolarizations, and torsade de pointes ventricu- lar tachyarrythmia (TdP VT). Hyperkalemia affects up to 8% of hospitalized patients mainly in the setting of compromised renal function. The ECG manifestation of hyperkalemia de- pends on serum K+ level. At 5.5–7.0 mmol/L K+, tall peaked, narrow-based T waves are seen. At > 10.0 mmol/L K+, sinus arrest, marked intraventricular conduction delay, ventricular techycardia, and ventricular fibrillation can develop. Isolated abnormalities of extracellular calcium (Ca++) produce clinically significant EP effects only when they are extreme in either direction. Hypocalcemia, frequently seen in the setting of chronic renal insufficiency, results in prolonged ST segment and QT interval while hypercalcemia, usually seen with hyperparathy- roidism, results in shortening of both intervals.
    [Show full text]
  • Front Matter (PDF)
    HIGH RATE OF SUCCESS IN AN NIH- STUDY of hypertensive patients- highest percentage - remained on itial therapy 83% with NORVASC#{174}(amlodipi besylate) after 4 years; nearly all pati were on the 5-mg starting dose’ LOW RATE DISCONTINUATION ONLY 1.5%of patients in placebo studies (n= 1730) discontinued due to adverse effects2 PROVEN No negative inotropic effects clinical doses in hemodyna m ic stud 2* No clinically significant effect on cardiac conduction or heart rate2 *S1IflH,jr fiernodynamic findings, hcvever fiave been agents possessing significant neqafive notropic ebecto and 10-mg tablets Once-Daily NORV (ambdipine EFFICACY AND SAFETY THAT’S EASY TO WITH Br$e(Summary NORVASC(amlodlpine besylate) Tablets For Oral Use CONTRAINDICATIONS: NORVASC is contraindicated in patients with known sensitivity to arniodipirre. In hypertension WARNINGS: Increased Angina and/or MyOcardIal Infarction: Rarely, patients, particulady those with severe obstruc5ve coronary artery disease, have developed documented increased frequency,durationand/or severity of angina or acute myocardial infarction on starhng cafrium channel blocker therapy or attire time of dosage increase. The mechanism of this effect has not been elucidated. PRECAUTIONS: General: Since the vasoditation induced by NORVASC is gradual in onset, acute hypotension has rarely been reported after oraladministrationof NORVASC. Nonethetuss, caution should be exercised when admin- or angina, convenient istering NORVASC as with any other penpherio vasodilator particularly in pahentswithsevere
    [Show full text]
  • Women'shealthreport
    Issue 4, 2014 Women’sHealthREPORT A QuaRTERLY PubLicatiON OF WOMEN’S HEALth diETEtic PRacticE GROup MICRONUTRIENTS AND THE OLDER ADULT – Part 1: Micronutrients of Importance to Older Adults By Vijaya Jain, MS, MSc, RD, CDN among older adults. A decreased energy intake associated with advancing age has important implications in terms of nutrient intake among older adults, including protein and micronutrients. Suboptimal intake for several micronutrients is prevalent among older adults. INTRODUCTION Increasing life expectancy has led to a steady rise in the number of older persons globally. In 2012, the number of older Americans aged 65 years and older had reached 43.1 million (1). As many of these older Americans continue to remain healthy and active well into their eighties and even nineties, and have better medi- cal management of chronic diseases and their comorbidities, the size of the older population is projected to double between 2000 and 2030 (2). According to the US Bureau of the Census, the size of the population age 85 and over is projected to be 7 Note from Chair: Collaboration is essential to the success of both million by 2020 (1). The baby-boomer generation will reach age individuals and organizations. It is has been a personal goal of mine 65 between 2010 and 2030, meaning that by 2030, one in five to see the Women’s Health DPG work with other DPGs and related American citizens will be older adults (1), and two out of every health organizations. In recent years, we have enhanced our mission three older Americans will have multiple chronic conditions (3).
    [Show full text]
  • Rhode Island Chapter Abstracts
    Rhode Island Chapter Abstracts April 1, 2015 Abdin, Ahmad Last Name: Abdin First Author: Resident First Name: Ahmad Category: Clinical Vignette PG Year: PGY-1 or MS Year: ACP Number: 2888549 Medical School or Residency Program: Warren Alpert Medical School of Brown University Hospital Affiliation: Memorial Hospital of Rhode Island, Providence VA Medical Center Additional Authors: Ahmad Abdin, MD, Mohammed Salhab, MD, Amos Charles, MD, Mazen Al-Qadi, MD Abstract Title: Amiodarone-Induced Cerebellar Dysfunction Abstract Text: Introduction: Amiodarone is a class III antiarrhythmic agent that is widely used to treat ventricular and supraventricular tachycardias. Several side-effects of the drug have been recognized including thyroid dysfunction, photosensitivity, hepatotoxicity, parenchymal lung disease, corneal deposits, and peripheral neuropathy. Cerebellar dysfunction is rarely seen in patients receiving amiodarone. We are reporting a rare case of amiodarone-induced cerebellar dysfunction that resolved completely upon discontinuation of the drug. Case Presentation: A 73-year-old man with a past medical history significant for paroxysmal atrial fibrillation, coronary artery disease, diabetes and hypertension who presented with worsening lower extremity weakness and unsteady gait with recurrent falls for the last 6 months. Two days prior to admission, his symptoms got worse and caused him to seek medical attention. Two years ago he was started and maintained on amiodarone 200 mg daily for rhythm control. On physical examination, vital signs were normal. A wide-based unsteady gait was noted. He had dysmetria bilaterally on finger-to-nose and heel-to-shin testing. The rapid alternating movements of the hands were irregular. The remainder of the general and neurologic examinations were unremarkable.
    [Show full text]
  • Nutrition Journal of Parenteral and Enteral
    Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/ Micronutrient Supplementation in Adult Nutrition Therapy: Practical Considerations Krishnan Sriram and Vassyl A. Lonchyna JPEN J Parenter Enteral Nutr 2009 33: 548 originally published online 19 May 2009 DOI: 10.1177/0148607108328470 The online version of this article can be found at: http://pen.sagepub.com/content/33/5/548 Published by: http://www.sagepublications.com On behalf of: The American Society for Parenteral & Enteral Nutrition Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> Version of Record - Aug 27, 2009 OnlineFirst Version of Record - May 19, 2009 What is This? Downloaded from pen.sagepub.com by Karrie Derenski on April 1, 2013 Review Journal of Parenteral and Enteral Nutrition Volume 33 Number 5 September/October 2009 548-562 Micronutrient Supplementation in © 2009 American Society for Parenteral and Enteral Nutrition 10.1177/0148607108328470 Adult Nutrition Therapy: http://jpen.sagepub.com hosted at Practical Considerations http://online.sagepub.com Krishnan Sriram, MD, FRCS(C) FACS1; and Vassyl A. Lonchyna, MD, FACS2 Financial disclosure: none declared. Preexisting micronutrient (vitamins and trace elements) defi- for selenium (Se) and zinc (Zn). In practice, a multivitamin ciencies are often present in hospitalized patients. Deficiencies preparation and a multiple trace element admixture (containing occur due to inadequate or inappropriate administration, Zn, Se, copper, chromium, and manganese) are added to par- increased or altered requirements, and increased losses, affect- enteral nutrition formulations.
    [Show full text]
  • Severe Hypermagnesemia Presenting with Abnormal Electrocardiographic Findings Similar to Those of Hyperkalemia in a Child Undergoing Peritoneal Dialysis
    Case report Korean J Pediatr 2013;56(7):308-311 http://dx.doi.org/10.3345/kjp.2013.56.7.308 pISSN 1738-1061•eISSN 2092-7258 Korean J Pediatr Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis Won Kyoung Jhang, MD, PhD, Yoon Jung Lee, MD, Young A Kim, MD, Seong Jong Park, MD, PhD, Young Seo Park, MD, PhD Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from Corresponding author: Young Seo Park, MD, PhD the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as 138-736, Korea hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis Tel: +82-2-3010-3376, Fax: +82-2-473-3725 successfully returned the serum magnesium concentration to normal without complications. When E-mail: [email protected] abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered. Received: 3 December, 2011 Revised: 17 April, 2012 Key words: Magnesium, Peritoneal dialysis, Hyperkalemia Accepted: 12 July, 2012 Introduction Hypermagnesemia is an uncommon clinical condition. Symptomatic hypermagnesemia usually occurs in elderly individuals and in patients with bowel disorders or renal insuffi­ ciency in the setting of excessive magnesium ingestion1­5).
    [Show full text]