Magnesium Deficiency (Hypomagnesemia): Causes

Pathogenesis (development of disease)

Approximately 99% of magnesium in the body is intracellular (“inside the cell”). Thus, measurement of magnesium in serum does not optimally represent magnesium balance. Magnesium distribution:

  • 50-65% = freely ionizing form of magnesium.
  • 20 % = Mg2+ bound to plasma protein
  • 20-25 % = Mg2+ forms complexes with phosphate, oxalate and other anions.

In the majority of cases, hypomagnesemia is due to inadequate magnesium intake and renal (kidney-related) magnesium losses; more rarely, enteric (intestinal) magnesium losses are present. Where this condition is clearly attributable to a disease, it is indicated below.

Etiology (causes)

Biographic causes

  • Genetic burden/disease
    • Familial hypomagnesemia with hypercalciuria (increased excretion of calcium in the urine) and consecutive nephrocalcinosis (deposition of calcium salts in the parenchyma of the kidney) due to a mutation in the paracellin-1 gene
    • Gitelman syndrome – genetic condition leading to increased loss of potassium and magnesium through the kidney.

Behavioral causes

  • Nutrition
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients: Hypomagnesemia
  • Consumption of stimulants

Disease-related causes

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Diabetes mellitus type 1/type 2 (glucosuria) [renal magnesium loss].
  • Hyperaldosteronism [renal magnesium loss]
  • Hypercalcemia [renal magnesium loss due to inhibition of tubular magnesium reabsorption]
  • Hyperthyroidism (e.g., Graves’ disease) [renal magnesium loss]
  • Hypoparathyroidism (parathyroid hypofunction) [renal magnesium loss]
  • Malnutrition
  • Metabolic acidosis (metabolic acidosis) [renal magnesium loss].

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder, and biliary tract-pancreas (pancreas) (K70-K77; K80-K87).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon or rectum.
  • Malassimilation syndrome – complex of symptoms of different genesis (origin) as a result of malabsorption (Latin “poor absorption“), maldigestion (decreased utilization of nutrients) or the combination of both symptoms.
  • Crohn’s disease – chronic inflammatory bowel disease; it usually runs in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, it may be affected several intestinal segments that are separated by healthy sections from each other
  • Non-infectious gastroenteritis, unspecified.
  • Celiac disease (synonyms: celiac disease; coeliac disease; indigenous sprue; gluten allergy; gluten-induced enteropathy; gluten-sensitive enteropathy; gluten intolerance) – chronic disease of the small intestinal mucosa due to hypersensitivity to the cereal protein gluten.

Psyche – nervous system (F00-F99; G00-G99).

  • Alcohol abuse
  • Anorexia nervosa (anorexia)
  • Delir
  • Laxative abuse (misuse of laxatives).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Diarrhea (diarrhea)

Other causes

  • Enteral fistulas
  • Enterostomy (artificial bowel outlet)
  • Parenteral nutrition (“bypassing the intestine”) without added magnesium.

Medication

Note: For literature on the topic of risk groups of magnesium deficiency, see “Micronutrient Medicine/Magnesium/Risk Groups”.