Durlach J, Durlach V, Bac P, Bara M, Guiet-Bara A
SDRM, Hôpital St. Vincent-de-Paul, Paris, France.
Magnes Res. 1994 Dec;7(3-4):313-28.
Two different types of therapy with magnesium are used: physiological oral magnesium supplementation which is totally atoxic since it palliates magnesium deficiencies by simply normalizing the magnesium intake and pharmacological magnesium therapy which may induce toxicity since it creates iatrogenic magnesium overload. Primary and secondary magnesium deficiencies constitute the sole indication of physiological oral magnesium therapy. It is therefore necessary to be well acquainted with the clinical and paraclinical pattern of magnesium deficit and to discriminate between magnesium deficiency due to an insufficient magnesium intake which only requires oral physiological supplementation and magnesium depletion related to a dysregulation of the control mechanisms of magnesium status which requires more or less specific regulation of its causal dysregulation. Physiological oral magnesium load constitutes the best tool for diagnosis of magnesium deficiency and the first step of its treatment. Physiological oral magnesium supplementation (5 mg/kg/day) is easy and can be carried out in the diet or with magnesium salts, with practically only one contra-indication: overt renal failure. Specific and aspecific treatments of magnesium depletion are tricky using for example magnesium sparing diuretics, pharmacological doses of vitamin B6, physiological doses of vitamin D and of selenium. In order to use the pharmacological properties of induced therapeutic hypermagnesaemia, high oral doses of magnesium (> 10 mg/kg/day) are advisable for chronic indications and the parenteral route is suitable for acute indications. There are 3 types of indications: specific (for the treatment of some forms of magnesium deficit i.e. acute), pharmacological (i.e. without alterations of magnesium status) and mixed--pharmacological and aetiopathogenic--(for example complications of chronic alcoholism). Today pharmacological magnesium therapy mainly concerns the obstetrical, cardiological and anaesthesiological fields. The main indications are eclampsia, some dysrhythmias (torsades de pointe particularly) and myocardial ischaemias. But it is now difficult to situate the exact place of the pharmacological indications of magnesium. Magnesium infusions can only be envisaged in intensive care units with careful monitoring of pulse, arterial pressure, deep tendon reflexes, hourly diuresis, electrocardiogram and respiratory recordings. High oral magnesium doses besides their laxative action may bring latent complications which may reduce lifespan. There may remain some indications of the laxative and antacid properties of non soluble magnesium, particularly during intermittent haemodialysis. Lastly local use of the mucocutaneous and cytoprotective properties of magnesium is still valid, in cardioplegic solutions and for preservation of transplants particularly.
生理性口服镁补充，这是完全无毒的，因为它通过简单地使镁摄入正常化来缓解镁缺乏；以及药理镁治疗，这可能会导致毒性，因为它会造成医源性镁过载。原发性和继发性镁缺乏是生理性口服镁治疗的唯一适应症。因此，有必要充分了解镁缺乏的临床和辅助检查模式，并区分由于镁摄入不足导致的镁缺乏（仅需要口服生理性补充）和与镁状态控制机制失调相关的镁耗竭（这需要对其因果失调进行或多或少的特异性调节）。生理性口服镁负荷是诊断镁缺乏的最佳工具及其治疗的第一步。生理性口服镁补充（5毫克/千克/天）很容易，可以在饮食中或与镁盐一起进行，实际上只有一个禁忌症：明显的肾衰竭。使用例如保镁利尿剂、药理剂量的维生素B6、生理剂量的维生素D和硒等对镁耗竭进行特异性和非特异性治疗很棘手。为了利用诱导治疗性高镁血症的药理特性，对于慢性适应症，建议口服高剂量镁（>10毫克/千克/天），而肠胃外途径适用于急性适应症。有三种适应症类型：特异性（用于治疗某些形式的镁缺乏，即急性）、药理（即镁状态无改变）和混合性——药理和病因致病——（例如慢性酒精中毒的并发症）。如今，药理镁治疗主要涉及产科、心脏病学和麻醉学领域。主要适应症是子痫、一些心律失常（特别是尖端扭转型室速）和心肌缺血。但现在很难确定镁的药理适应症的确切位置。只有在重症监护病房并仔细监测脉搏、动脉压、深腱反射、每小时尿量、心电图和呼吸记录的情况下，才可以考虑输注镁。高剂量口服镁除了有通便作用外，还可能带来潜在并发症，可能会缩短寿命。不可溶性镁的通便和抗酸特性可能仍有一些适应症，特别是在间歇性血液透析期间。最后，镁的粘膜皮肤和细胞保护特性的局部应用仍然有效，特别是在心脏停搏液中以及用于移植保存。
