Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment

doi:10.1016/0002-8703(79)90108-X

American Heart Journal

Volume 97, Issue 1, January 1979, Pages 12-18

https://doi.org/10.1016/0002-8703(79)90108-X Get rights and content

Abstract

Thirty-four patients suspected of being magnesium deficient were given intravenous infusions of potassium and magnesium. The muscle contents of sodium, potassium, magnesium, and chloride were determined by atomic absorption spectrophotometry on skeletal muscle samples obtained by percutaneous biopsies. The frequency of ventricular etopic beats (VEBs) was assessed from a 3-hour ECG tape recording before the infusions and after the completion of each infusion. The potassium infusions did not result in any changes in the cellular potassium content, nor in the frequency of VEBs. After the magnesium infusions, however, a significant increase was noted in the cellular potassium content and likewise a significant decrease in the frequency of VEBs. This emphasizes the importance of magnesium in potassium metabolism.

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Moreover, increased aldosterone enhances the excretion of potassium and independently causes loss of magnesium from the body via urinary excretion. Because magnesium acts as a cofactor for muscle ATP production, required for the activation of Na+/K+ pumps in skeleteal muscle, which is essential for contractile performance, decreased magnesium may negatively influence on the muscle function [29]. These mechanisms can explain the possible role of alteration of the renin–angiotensin–aldosterone system by high salt intake for the loss of muscle mass and function.
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Data from a total of 7162 participants (3545 men and 3617 postmenopausal women) aged 45 years or older were obtained from multiple Korea National Health and Nutrition Examination Surveys (2008–2010) and analyzed. The total amount of sodium excreted in the urine in a 24-h period was estimated with spot urine specimens. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight (ASM/Wt) that was less than 1 standard deviation below the sex-specific mean for young adults.
E24UNA values were positively correlated with body mass index, waist circumference, total fat mass, and blood pressure; in contrast, E24UNA values were negatively correlated with ASM/Wt in both sexes. Compared with those in the lowest E24UNA tertile, participants in the highest E24UNA tertile were at higher risk for sarcopenia (men: odds ratio (OR) = 1.3 [95% confidence interval (CI) = 1.07–1.59]; women: OR = 1.41 [95% CI = 1.16–1.73]). Further classification of subjects with sarcopenia into sarcopenic obese and sarcopenic nonobese groups revealed that the highest E24UNA values were found in the sarcopenic obese group; this difference was statistically significant. The next highest levels were found in the sarcopenic nonobese group, followed by the nonsarcopenic group. This trend was observed in both sexes.
High E24UNA values were independently associated with both sarcopenia and obesity in Korean individuals older than 45 years. These results suggest that high salt intake may have a deleterious effect on body composition.
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A patient of a clinical pharmacology colleague had erosion of a Slow-K tablet into the wall of the esophagus, at the site where the esophagus was indented by an enlarged left atrium. More importantly, potassium supplements do not restore intracellular potassium unless given with magnesium.23-25 There are better ways to correct or prevent potassium depletion.
It has been proposed that cardiovascular risk could be markedly reduced by prescribing a single daily pill to all patients at risk. This concept is bad medicine, because each constituent has problems, and the problems are different for each patient. A key principle of clinical pharmacology is individualization of therapy. Patients are not all the same, so a single polypill cannot work for all of them. For patients with resistant hypertension, at least 3 different versions would be needed for patients with different causes of hypertension, and even then not one pill would be suitable for all patients.
Il a été avancé que le risque cardiovasculaire pourrait nettement être réduit en prescrivant une pilule à prise monoquotidienne à tous les patients exposés à un risque. On ne peut pas dire que ce concept relève de la bonne médecine puisque chaque composant présente des problèmes, et que les problèmes sont différents d’un patient à l’autre. Un principe clé de la pharmacologie clinique est l’individualisation du traitement. Les patients étant tous différents, une seule polypilule ne peut fonctionner pour tous. En ce qui concerne les patients souffrant d’une hypertension artérielle réfractaire, au moins 3 versions différentes seraient nécessaires chez ceux dont les causes d’hypertension artérielle diffèrent, et déjà une seule pilule ne conviendrait pas à tous les patients.
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Remarkably, (PhSe)2 intake attenuated the increase of triglycerides and cholesterol levels caused by HFD or HCTZ intake, which indicates that in the present study it has strong modulation of lipid profile rather than glycemic profile. A very common adverse effect of the chronic use of thiazides is the loss of potassium and magnesium, leading to hypokalemia and hypomagnesemia [55]. Hypokalemia has been reported to cause various clinical complications like muscle weakness, cramping, lethargy and serious cardiac arrhythmias [56,57].
The study evaluated whether a diet containing diphenyl diselenide (PhSe)₂, a synthetic antioxidant, could reduce the biochemical alterations induced by chronic consumption of highly enriched fructose diet and/or hydrochlorothiazide (HCTZ). Rats were fed a control diet (CT) or a high fructose diet (HFD), supplemented with or not HCTZ (4.0 g/kg) and/or (PhSe)₂ (3 ppm) for 18 weeks. HFD intake increased significantly plasma glucose, fructosamine, triglycerides and cholesterol levels. (PhSe)₂ supplementation significantly reduced triglycerides and cholesterol but could not restore them to control levels. The combination of HFD and HCTZ significantly altered plasma glucose, fructosamine, triglycerides and cholesterol levels which were not restore by (PhSe)₂ supplementation. Lipid peroxidation, protein carbonyl formation, vitamin C level and catalase activity decreased after HFD, HCTZ or HFD plus HCTZ ingestion. Remarkably (PhSe)₂ supplementation restored the oxidative stress parameters. HCTZ decreased renal superoxide dismutase (SOD) activity, which was restored to control levels by (PhSe)₂. Furthermore, the association of HFD and HCTZ decreased plasma potassium levels and aggravated HCTZ-induced hypomagnesemia and hypertriglyceridemia. Here we provided evidence of the involvement of oxidative stress and metabolic disorders in a rat model of HFD associated or not with HTCZ. (PhSe)₂ supplementation reduced the oxidative stress and this compound should be considered for the treatment of biochemical disturbances and oxidative stress in other animal models of metabolic disorders.
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Citation Excerpt :
Problematic in this determination is the fact that serum magnesium concentrations may not accurately reflect total body or intracellular magnesium. Patients receiving regular diuretics or patients who are chronic alcoholics may be total body magnesium deplete but may have normal serum magnesium levels.29,30 This study aimed to answer the question of whether magnesium sulfate could, within the first 2.5 hours of presentation and when added to usual care, safely and effectively reduce the ventricular response rate in adult emergency department (ED) patients with rapid atrial fibrillation.
We examine the safety and efficacy of magnesium sulfate infusion, in addition to usual care, for acute rate reduction in patients with atrial fibrillation and a rapid ventricular response rate.
This was a prospective, randomized, double-blind, placebo-controlled trial of intravenous magnesium sulfate in adult emergency department patients with rapid atrial fibrillation. Study solutions were given in addition to any therapy the treating physician would normally consider appropriate, including the use of standard rate-reduction agents. Patients received either 20 mEq (2.5 g, 10 mmol) magnesium sulfate over a 20-minute period, followed by 20 mEq (2.5 g, 10 mmol) over a 2-hour period intravenously, or placebo.
One hundred ninety-nine patients were randomized, 102 to receive magnesium sulfate and 97 to receive placebo. The antiarrhythmic drug most commonly used by treating physicians was digoxin. Magnesium sulfate was more likely than placebo to achieve a pulse rate of less than 100 beats/min (63 [65%] of 97 versus 32 [34%] of 93, relative risk [RR] 1.89; 95% confidence interval [CI] 1.38 to 2.59; P<.0001) and more likely to convert to sinus rhythm (25 [27%] of 94 patients versus 11 [12%] of 91 patients; RR 2.20; 95% CI 1.15 to 4.21; P=.01). Comparative mean pulse rate reductions in the magnesium sulfate group did not reach predetermined clinical significance levels (≥15 beats/min reduction) at any of the measured time points. Magnesium sulfate was more likely to be associated with an adverse event (14 [15%] of 95 patients versus 5 [5%] of 92 patients; RR 2.71; 95% CI 1.02 to 7.23; P=.04).
Magnesium sulfate, when used to supplement other standard rate-reduction therapies, enhances rate reduction and conversion to sinus rhythm in patients with rapid atrial fibrillation.
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^☆: Financial support was given by the Swedish National Association against Heart and Lung diseases and by AB Ferrosan, Malmö, Sweden.

^∗: Dept. of Medicine, Serafimerlasarettet, Stockholm.

^∗∗: Dept. of Medicine, University Hospital, Umeå, Sweden.

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Clinical communicationVentricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment☆

Abstract

J. Pediatr.

Metabolism

Lancet

Am. J. Med.

J. Pediatr.

Medicine

N. Engl. J. Med.

Interrelations of magnesium, potassium, phosphorus and creatine in skeletal muscle of man

J. Clin. Invest.

Muscle electrolytes in man determined by neutron activation analysis on needle biopsy specimens. A study on normal subjects, kidney patients, and patients with chronic diarrhoea

Scand. J. Clin. Lab. Invest. (Suppl.)

The effect of mefruside on plasma and muscle electrolytes and blood pressure in normal subjects and in patients with essential hypertension

Acta Med. Scand.

Messungen des Membranpotentials an einzelnen quergestreiften Muskelzellen der Menschen in situ

Klin. Wschr.

Magnesium in cardiac arrhythmia

N. Engl. J. Med.

The extra renal correction of alkalosis associated with potassium deficiency

J. Clin. Invest.

Ventricular premature beats in a population sample. Frequency and associations with coronary risk characteristics

Circulation

Clinical communication
Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment☆