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Magnesium and phosphorus

1998; Elsevier BV; Volume: 352; Issue: 9138 Linguagem: Inglês

10.1016/s0140-6736(05)61306-2

1474-547X

JR Weisinger, Ezequiel Bellorín-Font,

Potassium and Related Disorders

Authors' reply Sir—Peter Schuck and colleagues are correct in their comment about the concentration of magnesium in figure 1. It refers to total serum magnesium and not to ionised magnesium, as it would appear with the notation [Mg2+]. Andrew Davenport's comment about hypophosphataemia from CRRT could be included as an additional cause of hypophosphataemia, as he suggests. The main mechanism seems to be phosphate loss in the dialysate effluent. However, a shift of phosphate to the intracellular compartment could be an additional mechanism of hypophosphataemia from respiratory alkalosis. With regard to the comments by W Terryn and D Van Caesbroeck, we would like to insist that oral replacement is the safest mode of therapy for patient with mild or moderate hypophosphataemia. However, in cases with severe symptomatic hypophosphataemia due to phosphate depletion, there is no doubt that the parenteral route is the most effective and reliable. In addition, in cases of hypophosphataemia secondary to severe diarrhoea, the parenteral administration of phosphorus could assure prompt correction of phosphate deficit without the risk of aggravating diarrhoea. Magnesium and phosphorusJosé R Weisinger and Ezequiel Bellorín-Font's excellent article on magnesium and phosphorus (Aug 1, p 391)1 underlines the importance of routinely measuring serum magnesium, especially patients in intensive-care units, patients with extraordinary needs for potassium supplementation, alcoholics, and patients with diabetes. Since there are no signs and clinical manifestations are non-specific or attributed to other causes, magnesium deficiency is the most overlooked electrolyte alteration among hospital inpatients. Full-Text PDF Magnesium and phosphorusJosé R Weisinger and Ezequiel Bellorín-Font1 do not give a full account of hypophosphataemia. Phosphate retention occurs in acute and chronic renal failure, and although phosphate is mainly an intracellular anion, this results in hyperphosphataemia. Whereas most patients with chronic renal failure have an increased total body phosphate, those who develop acute renal failure, may not, especially patients with a history of alcohol abuse, chronic diarrhoeal illnesses, antacid prescription, and proximal renal tubular disorders. Full-Text PDF Magnesium and phosphorusWe are concerned by José R Weisinger and Ezequiel Bellorín-Font's statement1 that “the safest mode of therapy is oral. 1000 mg phosphorus per day will usually correct phosphate depletion”. This recommendation is incorrect because the absorption of enteral supplemental phosphate is unreliable, more so in the case of diarrhoea, which is frequently provoked by phosphate salts.2 Full-Text PDF