Is there a place in therapy for the tiotropium device known as a spiriva respimat ??
Hypomagnesaemia is a condition caused by abnormalities in the levels of magnesium in the body (Marshall and Bangert). This abnormality in the magnesium levels causes disturbances in the functioning of various body organs and therefore results to fatal complications [2]. The current issues on hypomagnesaemia indicate that such complications may involve coronary artery vasospasm, ventricular arrhythmia, and even sudden death. Magnesium has recognized importance in human body, despite these importance, high and low levels of magnesium among patients has made magnesium earn the name “the forgotten cation.” Magnesium has a fundamental role in the working of the cell. This includes storage of energy as well as its transfer and use, metabolism of fats, proteins and carbohydrates, and regulating the secretion of parathyroid hormone (PTH) [5].
Research findings have although found that despite various undertreated and under diagnosed [3]. This bulletin gives a discussion on the treatment of chronic hypomagnesaemia.
Summary
? The likelihood of having Hypomagnesaemia can be detected through hypocalcemia, chronic diarrhea, ventricular arrhythmias especially in ischemic event, and refractory hypokalemia [4].
? In a scenario where the situation becomes life threatening, plasma magnesium concentration is assessment from a drawn blood sample is of great importance. In the case where renal functioning seems to be normal, immediate intravenous magnesium prescription is provided.
? If there is a confirmation of hypomagnesaemia, the best place to obtain diagnosis is from history [2]. In cases of no apparent cause, the existing difference between the renal losses and gastrointestinal is obtained through a 24 hours urinary magnesium excretion or excreting magnesium in fractional portions of a urine specimen.
? Detecting the underlying magnesium depletion can be through the demonstration of reduced excretion of over 80% in 24 hours.
The main causes of hypomagnesaemia relate to decreased magnesium intake, and it’s mainly caused by factors such as:
Treatment of hypomagnesaemia in the community
Incidence In terms of incidence, hypomagnesaemia occurs mainly to hospitalized patients, accounting for slightly over 12%, but the figure may rise as high as 60 to 65% in patients in intensive care backgrounds, where elements of diuretics, nutrition, aminoglycosides, and hypoalbuminemia may play significant roles [5]. Treatment of Treatment of hypomagnesaemia in the community BULLETIN Date: 00/00/2012 By Hesham Alhamad ID:501923 Volume.1 By Hesham Alhamad No.1 ID.501923 Background Etiology
Treatment of hypomagnesaemia in the community Bulletin Date: 00/00/2012 By: Hesham Alhamad ID.501923
Diagnosis Diagnosis is made by measuring the plasma magnesium concentration levels, where the level of 0.7 mmol/l or less confirms hypomagnesaemia. Hypomagnesaemia can also be suspected and diagnosed following consistence incidences of refractory hypokalemia, hypocalcemia, chronic diarrhea, and ventricular arrhythmias [4]. Treatment Severity of the clinical manifestations determines the intensity of magnesium repletion. A case where a hypocalcemic-hypomagnesaemic patient or a case where a patient is suspected to have hypomagnesaemic-hypokalemic, such a patient should have a prescription of 50 mEq of intravenous magnesium [1] .The table below shows other forms that hypomagnesaemia manifests itself and their dosage. Form of disease Dosage Prophylaxis or Asymptomatic: ( < 1.4) 4-12 gm/day given IM/IV in D5W; Symptomatic HypoMg: ( < 1.4) Mild-up to 10 gm in 6 hrs Severe cases- 6 gm IV over 3 hrs, then 3 gm q12 hrs; Misc 80 mEq of Mg sulfate (20 ml of 50% solution) to 1 liter over 4-6 hr. Hypomagnesaemic-hypokalemic 50 mEq of intravenous magnesium
It is necessary to repeat the above dosage for maintaining the concentration of plasma magnesium above 1.0 mg/dl (0.4 mmol/L or 0.8 mEq/L. In cases of normomagnesemic patients with hypocalcemia, the dosage is repeated for 3to 5 days [5]. The major regulator of the reabsoption process of magnesium in the loop of Henle is the concentration of plasma magnesium. This means that abrupt increase in the concentration of plasma magnesium results to the removal of stimulus from magnesium retention [2].Oral replacement is the best procedure for the asymptomatic patients with the accompaniment of a sustained-release preparation. The available preparations of such kinds include the slow-mag, which contains magnesium chloride, as well as the Mag-Tab SR, which contains magnesium lactate (Davies and Cashman). Diuretic and who cannot seize diuretic therapy may have benefits through the addition of potassium-sparing diuretic like the amiloride [4].
In the cases of mild asymptomatic disease, two to four tablets are sufficient. Hypomagnesemia patients whose illness got induced by loop diuretic and who cannot seize diuretic therapy may have benefits through the addition of potassium-sparing diuretic like the amiloride [4]. In a nutshell, treatment mostly depends on the type of hypomagnesaemia, but may include:
? Fluids provided via IV
? Magnesium given via mouth or through a vein
? Provision of other medications aimed at relieving pain
This condition can also be treated via lifestyle changes and eating of health diets, most specifically green vegetables, legumes, nuts, whole grains, and seeds which are good sources of magnesium. In addition, patients with hypomagnesaemia should be examined regularly to confirm any evidence of magnesium deficit. If the condition persists, the patient should be introduced to an oral sustained-release preparation [3]. References References:
1. Cloherty JP .Manual of Neonatal Care. New York: Lippincott Williams & Wilkins;2007.
2. Davies NJ , Cashma, JN. Synopsis of Anaesthesia. Philadelphia: Elsevier Health Sciences;2005.
3. Hillman KT, Bishop GM. (2004). Clinical Intensive Care and Acute Medicine. Cambridge:Cambridge University Press;2004.
4. Marshall WJ, Bangert SK. Clinical Chemistry. Philadelphia: Elsevier Health Sciences;2008.
5. Murray MJ, Coursin DB , Prough DS.Critical Care Medicine: Perioperative Management. NewYork: Lippincott Williams & Wilkins;2007.
Conclusion: In enhancing the treatment of hypomagnesaemia, it is important to council the patients on the modification of risks of the disease. These modifications includes avoiding the consumption of alcoholic drinks, maintaining healthy and proper eating habits, proper intake of supplements as well as having major improvements in diabetic control. The healthcare service providers should keep tabs in embracing the modern techniques hypomagnesemia control and treatment. Adequate information should also be made available to everyone for a better control of the disease.
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Research findings have although found that despite various undertreated and under diagnosed [3]. This bulletin gives a discussion on the treatment of chronic hypomagnesaemia.
Summary
? The likelihood of having Hypomagnesaemia can be detected through hypocalcemia, chronic diarrhea, ventricular arrhythmias especially in ischemic event, and refractory hypokalemia [4].
? In a scenario where the situation becomes life threatening, plasma magnesium concentration is assessment from a drawn blood sample is of great importance. In the case where renal functioning seems to be normal, immediate intravenous magnesium prescription is provided.
? If there is a confirmation of hypomagnesaemia, the best place to obtain diagnosis is from history [2]. In cases of no apparent cause, the existing difference between the renal losses and gastrointestinal is obtained through a 24 hours urinary magnesium excretion or excreting magnesium in fractional portions of a urine specimen.
? Detecting the underlying magnesium depletion can be through the demonstration of reduced excretion of over 80% in 24 hours.
The main causes of hypomagnesaemia relate to decreased magnesium intake, and it’s mainly caused by factors such as:
Treatment of hypomagnesaemia in the community
Incidence In terms of incidence, hypomagnesaemia occurs mainly to hospitalized patients, accounting for slightly over 12%, but the figure may rise as high as 60 to 65% in patients in intensive care backgrounds, where elements of diuretics, nutrition, aminoglycosides, and hypoalbuminemia may play significant roles [5]. Treatment of Treatment of hypomagnesaemia in the community BULLETIN Date: 00/00/2012 By Hesham Alhamad ID:501923 Volume.1 By Hesham Alhamad No.1 ID.501923 Background Etiology
Treatment of hypomagnesaemia in the community Bulletin Date: 00/00/2012 By: Hesham Alhamad ID.501923
Diagnosis Diagnosis is made by measuring the plasma magnesium concentration levels, where the level of 0.7 mmol/l or less confirms hypomagnesaemia. Hypomagnesaemia can also be suspected and diagnosed following consistence incidences of refractory hypokalemia, hypocalcemia, chronic diarrhea, and ventricular arrhythmias [4]. Treatment Severity of the clinical manifestations determines the intensity of magnesium repletion. A case where a hypocalcemic-hypomagnesaemic patient or a case where a patient is suspected to have hypomagnesaemic-hypokalemic, such a patient should have a prescription of 50 mEq of intravenous magnesium [1] .The table below shows other forms that hypomagnesaemia manifests itself and their dosage. Form of disease Dosage Prophylaxis or Asymptomatic: ( < 1.4) 4-12 gm/day given IM/IV in D5W; Symptomatic HypoMg: ( < 1.4) Mild-up to 10 gm in 6 hrs Severe cases- 6 gm IV over 3 hrs, then 3 gm q12 hrs; Misc 80 mEq of Mg sulfate (20 ml of 50% solution) to 1 liter over 4-6 hr. Hypomagnesaemic-hypokalemic 50 mEq of intravenous magnesium
It is necessary to repeat the above dosage for maintaining the concentration of plasma magnesium above 1.0 mg/dl (0.4 mmol/L or 0.8 mEq/L. In cases of normomagnesemic patients with hypocalcemia, the dosage is repeated for 3to 5 days [5]. The major regulator of the reabsoption process of magnesium in the loop of Henle is the concentration of plasma magnesium. This means that abrupt increase in the concentration of plasma magnesium results to the removal of stimulus from magnesium retention [2].Oral replacement is the best procedure for the asymptomatic patients with the accompaniment of a sustained-release preparation. The available preparations of such kinds include the slow-mag, which contains magnesium chloride, as well as the Mag-Tab SR, which contains magnesium lactate (Davies and Cashman). Diuretic and who cannot seize diuretic therapy may have benefits through the addition of potassium-sparing diuretic like the amiloride [4].
In the cases of mild asymptomatic disease, two to four tablets are sufficient. Hypomagnesemia patients whose illness got induced by loop diuretic and who cannot seize diuretic therapy may have benefits through the addition of potassium-sparing diuretic like the amiloride [4]. In a nutshell, treatment mostly depends on the type of hypomagnesaemia, but may include:
? Fluids provided via IV
? Magnesium given via mouth or through a vein
? Provision of other medications aimed at relieving pain
This condition can also be treated via lifestyle changes and eating of health diets, most specifically green vegetables, legumes, nuts, whole grains, and seeds which are good sources of magnesium. In addition, patients with hypomagnesaemia should be examined regularly to confirm any evidence of magnesium deficit. If the condition persists, the patient should be introduced to an oral sustained-release preparation [3]. References References:
1. Cloherty JP .Manual of Neonatal Care. New York: Lippincott Williams & Wilkins;2007.
2. Davies NJ , Cashma, JN. Synopsis of Anaesthesia. Philadelphia: Elsevier Health Sciences;2005.
3. Hillman KT, Bishop GM. (2004). Clinical Intensive Care and Acute Medicine. Cambridge:Cambridge University Press;2004.
4. Marshall WJ, Bangert SK. Clinical Chemistry. Philadelphia: Elsevier Health Sciences;2008.
5. Murray MJ, Coursin DB , Prough DS.Critical Care Medicine: Perioperative Management. NewYork: Lippincott Williams & Wilkins;2007.
Conclusion: In enhancing the treatment of hypomagnesaemia, it is important to council the patients on the modification of risks of the disease. These modifications includes avoiding the consumption of alcoholic drinks, maintaining healthy and proper eating habits, proper intake of supplements as well as having major improvements in diabetic control. The healthcare service providers should keep tabs in embracing the modern techniques hypomagnesemia control and treatment. Adequate information should also be made available to everyone for a better control of the disease.
FOR MORE INFORMATION ON THIS TOPIC CLICK HERE
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