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Magnesium Chloride

Magnesium is abundant and has been identified as a cofactor in more than 300 enzymatic reactions involving energy metabolism and protein and nucleic acid synthesis. Magnesium chloride, magnesium gluconate, magnesium lactate, and magnesium oxide can serve as an antacid or laxative, and oral products are commonly used as supplements for patients with magnesium deficiency due to malnutrition, restricted diet, or magnesium-depleting drugs.

Magnesium sulfate is a salt that can be administered orally or parenterally. It is used orally as a laxative and parenterally as a neuromuscular depressant or to treat hypomagnesemia. Oral magnesium sulfate is a saline laxative used primarily to empty the bowel before procedures. Magnesium sulfate can be used in combination with charcoal to treat acute drug overdose. The primary use of parenteral magnesium sulfate is to prevent and control seizures in preeclampsia and eclampsia. Parenteral magnesium sulfate is also used to control seizures due to epilepsy, glomerulonephritis, or hypothyroidism. Parenteral magnesium can be considered as a treatment for cardiac glycoside-induced arrhythmias.

Mechanism of Action

Magnesium is a cofactor to all enzymes involved in phosphate transfer reactions that use ATP and other nucleotides as substrates. Magnesium ions are a cofactor for the ATP-dependent sodium-potassium "pump" found in muscle membranes. Without magnesium, the pump cannot function properly. Drugs that cause severe hypokalemia, such as cisplatin, amphotericin B, and loop diuretics, also cause hypomagnesemia. Correcting the imbalance facilitates the treatment of hypokalemia by improving the pump's ability to distribute potassium into the intracellular space. It’s believed that magnesium functions due to its ability to decrease calcium uptake and decrease potassium efflux at the myocardial cell membrane. Conversely, calcium is a direct antagonist of magnesium.

Magnesium is also required for the binding of intracellular macromolecules to organelles and mRNA to ribosomes. As a laxative, magnesium sulfate works in the small intestine via a hyperosmotic effect from stimulation of stretch receptors and peristalsis through retention of water.

The antacid effects of magnesium oxide involve reaction with water. In the presence of water, magnesium oxide is converted to magnesium hydroxide which rapidly reacts with gastric acid to form water and magnesium chloride, thereby increasing gastric pH.

As a treatment for severe asthma, magnesium decreases the uptake of calcium by bronchial smooth muscle cells, which results in bronchodilation. Magnesium may also inhibit mast cell degranulation, thus decreasing inflammatory mediators such as histamine, thromboxanes, and leukotrienes. Additionally, magnesium inhibits the release of acetylcholine from motor nerve terminals and depresses the excitability of muscle fiber membranes. Magnesium also decreases asthma severity by stimulating nitric oxide and prostacyclin synthesis.

High magnesium serum concentrations result in vasodilation, muscle relaxation, and sedation. Some studies have shown that magnesium can prevent and reduce hypoxia-induced pulmonary hypertension, leading to its use in the treatment of persistent pulmonary hypertension of the newborn (PPHN).

When used as an anticonvulsant, magnesium sulfate depresses the CNS and blocks peripheral neuromuscular transmission. Magnesium is a peripheral vasodilator and an inhibitor of platelet function. Large doses can lower blood pressure and cause CNS depression.

Pharmacokinetics
Contraindications/Precautions
Pregnancy/ Breastfeeding
Adverse Reactions/ Side Effects
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