Anti-hypertensive treatment with magnesium-aspartate-dichloride and its influence on peripheral serotonin metabolism in man: a subacute study.

Dichlormagnesium-aspartate-hydrochloride was given to 12 patients with mild hypertension in antihypertensive indication at a dose of 10.5 mmol Mg2+/day for 3 months. Blood pressure normalized (from 161.7 +/- 3.4/95.8 +/- 0.8 mmHg to 140.4 +/- 4.0/81.7 +/- 0.9 mmHg, after the third month (p < 0.01). While no changes in Mg2+ concentration in serum were observed in patients with normomagnesaemia, in hypomagnesaemic patients vS-Mg level normalized. Renal excretion of Mg2+ increased: from 3.41 +/- 0.36 before to 5.7 +/- 0.57 mmol Mg2+/24 h after treatment, p < 0.01. Mean plasma serotonin (5HT) concentration showed no changes, although a trend towards an increase in platelet 5HT content was observed. Elevated pre-treatment plasma 5-hydroxyindole acetic acid (5HIAA) concentrations normalized (from 137.29 +/- 20.3 to 78.96 +/- 31.64 nmol/l after the third month, p < 0.05). These findings point to a platelet-stabilizing effect of Mg2+. Fractional excretion of 5HIAA increased (from 1.42 +/- 0.27 to 5.4 +/- 1.22 after treatment, p < 0.01) while mean urinary 5HIAA excretion remained unchanged. It is deduced that a) total body 5HT and 5HIAA production was not affected; b) a long-term supplementation of Mg2+ stimulates the transport of 5HIAA in proximal tubules and, probably, intrarenal 5HIAA synthesis. A functional block in 5HT metabolism under Mg2+ treatment is anticipated. Thus, Mg2+ supplementation has renal and extrarenal effects that are important in treating hypertension and its complications.

[The effect of a single administration of magnesium sulfate on glucose tolerance and insulinemia in healthy volunteers]. / Vplyv jednorazového podania magnézium sulfátu na glukózotoleranciu a inzulinémiu u zdravých dobrovol'níkov.

The effect of 2.0 g magnesium sulfate on glucose tolerance and immunoreactive insulin (IRI) response to glucose application was studied in 10 healthy normomagnesemic volunteers: a) Serum magnesium concentration (Mg) increased markedly and remained on the increased values during the study. Total erythrocyte Mg concentration did not change. b) The infusion application of 40 g glucose increased glykemia which returned promptly to fasting levels after the infusion termination. Mg did not influence the glycemic response. c) IRI concentration increased even more than glucose to the glucose load. Mg decreased the IRI response and even IRI/glucose ratio significantly. In conclusion, Mg increased insulin sensitivity even in healthy normomagnesemic subjects.

[A decrease in magnesium in the serum and blood lymphocytes after intravenous infusion of glucose]. / Pokles magnézia v sére a v krvných lymfocytoch po intravenóznej infúzii glukózy.

The authors assessed in a group of 10 healthy volunteers the Mg content of serum, in erythrocytes (Er) and lymphocytes (Ly) before infusion and during three hours after infusion of 400 ml 10% glucose without added Mg and with addition of 10 ml 20% MgSO4 (magnesium sulphate, Spofa). It was revealed that glucose infusion without Mg reduces significantly serum magnesium as well as Mg in lymphocytes and the reduced values persist for at east three hours after termination of the infusion. In 3 of 10 volunteers the values dropped beneath the lower range of reference values; two of these three volunteers developed also clinical manifestations of Mg deficiency. Mg in Er was not affected by the glucose infusion. The glucose infusion with Mg raised significantly the serum Mg and Mg in Ly; Mg in Er did not change. Based on the submitted results the authors recommend prevention of Mg deficiency induced by glucose infusion by Mg supplementation, in particular in patients with cardiovascular diseases.

Blood lymphocyte magnesium in kidney stone formers.

Blood lymphocyte, serum and urinary magnesium analyses were performed in a randomized group of 36 kidney stone-formers with the aim to determine the incidence of intracellular and extracellular magnesium depletion in urolithiasis. Lymphocyte magnesium depletion was found in 10 patients, serum magnesium depletion in 5 and concomitant lymphocyte and serum magnesium depletion in another 3 patients. Thus intracellular and/or extracellular magnesium depletion was found in 15 patients (41.7%). Oral magnesium supplementation (5-10 mmol Mg2+ daily) was found in some patients ineffective in both lymphocyte and/or serum magnesium repletion.

Formation of calcium oxalate urolithiasis in experiment and its inhibition by pyridoxine and magnesium.

Possibility of application of experimental model of calcium oxalate urolithiasis to the study of some medicament actions useful in prevention of calcium oxalate urolithiasis in men has been examined in animal experiments. Inhibition effects of pyridoxine and magnesium in formation of calcium oxalate stone formation have been proved. Administration of pyridoxine and/or magnesium to experimental animals inhibited formation of incrustations on renal papillae. Administration of nothing but magnesium lowered considerably also frequency of nephrocalcinosis occurrence. Good reproducibility of applied model of calcium oxalate urolithiasis creates conditions for further experimental study of this kind of urolithiasis. In the previous series of experiments (4) we tiped out an experimental model of calcium oxalate urolithiasis in animals well reproducible in our conditions. In the following period we were interested, whether the created model can be applied to verification of efficiency and further study of some medicaments affecting this kind of urolithiasis. At present, pyridoxine and magnesium are mode widely used for prevention of calcium oxalate urolithiasis in the clinical practice. Therefore, we decided to use the possibilities of the evaluated experimental model for the study of their inhibition effects. The results of experiments are presented in this paper.

Urolithiasis in childhood.

On the basis of epidemiological study in closed children's population of Bratislava (350 000 inhabitants, out of them 70 000 children) the conclusions about falling urolithiasis incidence in children of urban population are drawn. Analysis and clinical evaluations of 287 children's patients with urolithiasis shows that in solitary calculi (in partial casts as well) the results of treatment are very good, repeated recurrences are rare. The results are considerably worse in multiple and great staghorn stones. The importance of first surgical treatment, in which all stones should be removed, as well as principles of both general and specific treatment in relationship with stone composition and metabolic disturbances are stressed.

Prognosis of urolithiasis and nephrocalcinosis in hypomagnesemia.

In 78 patients with hypomagnesemia in urolithiasis the clinical course of disease was established in relation to therapy and dynamics of changes of serum magnesium levels. Almost 70% of patients had multiple, bilateral or recurrent nephrolithiasis or nephrocalcinosis. 70% of patients had Ca-oxalate stones or bilateral nephrocalcinosis. In 52% of patients a long-term magnesium supplementation was necessary. Significant progress of nephrolithiasis and nephrocalcinosis was observed in 80% of patients with permanent hypomagnesemia and in 4% of patients with normalization of serum magnesium level. Three of 15 patients with hypomagnesemia and progress of disease were transplanted a kidney and two were treated by hemodialysis. All five patients with renal failure had bilateral nephrocalcinosis, in three of them familiar occurrence of nephrolithiasis and hypomagnesemia was found.

Dynamics of serum minerals changes after renal transplantation.

In 27 patients surviving with transplanted cadaver kidneys for 12-107 months, calcium, phosphorus, magnesium and creatinine serum levels, glomerular filtration rate and incidence of serum mineral levels pathological deviations following renal transplantation were evaluated. In early posttransplantation period hypercalcemia and hypomagnesemia developed in one fourth of the observed group of patients and hypophosphatemia in two thirds of patients. Expressive hypermagnesemia developed in one patient. Calcium and phosphorus levels gradually normalized, excluding rare exceptions; magnesium serum level exceeded an upper limit of normal values in majority of patients, nor to medicamentous treatment was stated.

Preparedness of patients to renal transplantation.

The outcome of renal transplantations depends to a considerable degree on the general condition of patients before the transplantation. The patients in the dialysis programme are regularly watched and any complications which might contraindicate the transplantation are recorded. Despite this, verging complications were repeatedly found which, by themselves, do not contraindicate the operation but may increase the risk of the operation and thereby the outcome of the transplantation. In the present study the general conditions of 38 patients coming from different dialysis centres in the Slovak Socialist Republic are assessed. These patients underwent renal transplantation at the Clinic of Urology in Bratislava.

Transient impairment of tubular reabsorption of calcium (TRCa) after renal transplantation.

TRCa calculations (using the values of plasma ultrafiltrable Ca and urinary Ca) revealed impaired renal Ca handling in 14/32 patients with transplanted kidneys. TRCa improved in relationship with the increment in renal transplant function, and was within the normal range in all patients with GFR above 50 ml/min. There was a positive correlation between serum Ca and TRCa; hypocalcaemia was found in 9 patients and hypercalcaemia in 3. In the majority of hypocalcaemic patients TRCa impairment was discovered, however, pathologically decreased serum Ca values were found in only one half of the patients with impaired TRCa. In most hypocalcaemic patients the concomitant renal transplant insufficiency, hyperphosphataemia and/or insufficient dietary Ca intake seemed likely to have contributed to serum Ca depletion.