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Month: December 2024

Magical Metal Magnesium 

Magical Metal Magnesium 

Magnesium with its atomic number (AN12) is sandwiched between sodium (AN11) and aluminum (AN13) on the periodic table.  It also sits above calcium (AN20).  All four elements are metals.  Magnesium and calcium have two “available” electrons in their outermost orbital ring, which can help explain some of the medicinal applications of magnesium.   

Magnesium is found in all cells in all organisms both plant and animal.  It is indispensable for health as it is an essential cofactor for ATP (adenosine triphosphate) the battery molecule that powers all of our cells.  It is also a cofactor for hundreds of cellular enzymes.  In addition, it regulates metabolism of sugars, fats and proteins, helps control nerve and muscle function, regulates cardiac rhythm, modulates blood vessel tone and regulates hormone secretion.   

Whew.  With all those important jobs you would think we would hear more about magnesium and that there might be more than three medical conditions where it is the drug of choice.   

There are a number of medical applications where it isn’t the drug of choice.  It has GI benefits as both an antacid and a laxative.  It can increase the seizure threshold for epileptics.  It can lessen the frequency of migraines.  It can help muscle spasms including tetany.  It is integral for good bone matrix formation.  One unwanted side effect of long use protein pump inhibitors is their impact on micronutrient absorption including magnesium and thereby reducing bone density.   

But, the three conditions where it is the treatment of choice are torsade de pointes, acute asthma exacerbation, and preeclampsia/eclampsia.   Torsade de pointe is a life-threatening form of ventricular tachycardia.  It is often resistant to treatment with standard Anti arrhythmias such as beta blockers.   

Eclampsia/preeclampsia is a condition in pregnant women that can threaten the woman’s life and the baby’s.  The mother experiences fluid retention and elevated blood pressure which if severe can cause a seizure or stroke for the women and death for the baby.  Preeclampsia is helped by oral magnesium.  Eclampsia is treated with intravenous magnesium.   

In severe hospitalized asthma, magnesium is used both intravenously and also by adding it to the albuterol used in nebulizer treatments.  

Its mechanism of action has been best understood in asthma but it probably applies to all the conditions just described.  It is a natural calcium channel blocker.  Calcium channels are portals of flow for calcium ions in many tissues.  In bronchial smooth muscle calcium channels can cause the constriction of these muscles which in turn narrows the airways.  Blocking the channel with magnesium allows the muscles to relax and the airways to open.  Remember in the introduction to this article the close proximity of calcium and magnesium and the two available electrons in the outer shell.  This allows magnesium to bump calcium out of the channel, kind of a “preferred passenger status”.   

Dear Dr. K; 

Dear Dr. K; 

I just turned 65 and I want to get a pneumonia vaccine, but quite honestly, I’m confused by the choices.   

The confusion is not unique to you.  There has been a longitudinal/temporal change/improvement in the vaccine.   To cut to the chase the CDC Advisory Committee on Immunization Practices recommends you (as previously unvaccinated) receive PCV21 followed a year later by PPSV23.   

By way of explanation, PPSV stands for pneumococcal polysaccharide vaccine.  It is the original vaccine and is similar in formulation to the tetanus vaccine.  PCV stands for pneumococcal conjugate vaccine.  In this format the polysaccharide antigens are conjugated to a diphtheria protein to elicit a more robust immune response.  With the learning curve of time, scientists have found using both formats leads to the best and most durable immune response.   

The earliest conjugate vaccine was PCV13 (protecting against 13 of the most common pneumonia types).  Over time PCV15, PCV20 and then PCV21 have come along.  PCV21 includes 8 serotypes not included in any of the other vaccines.  Hence, the CDC’s current advice. 

Damned if you do, Damned if you don’t 

Damned if you do, Damned if you don’t 

By; Sasha Klemawesch, MD 

Here’s a doozy of a “Would-You-Rather”: Would you prefer continuing to deal with chronic unremitting knee pain, or would you rather have several days of unrelenting hiccups? 

Those may seem totally unrelated, but actually, a little known (though not altogether uncommon) side effect of steroid injections is intractable hiccupping! 

This was news to me too, but one of my colleague’s fell victim to it recently and was absolutely miserable for days. His knee was great! To the point he was actually able to resume jogging! But he said in the future, he’d take the long-term arthritis over the short-term hiccups.  

Those two things seem so completely unrelated, I thought it couldn’t possibly be true that the knee injection caused his hiccups, but turns out there are myriad reports in the literature about this very phenomenon.  

“Singulata” (aka the medical term for hiccups) are caused by a reflex arc involving various nerve pathways, the diaphragm musculature, and multiple neurotransmitters including dopamine, serotonin, GABA, et al. Anything that may dysregulate any one of those components has the potential to trigger hiccupping. And steroids, particularly high-Dose steroids are a known potential risk to upset that fine balance.   

This unusual reaction is much better known in the fields of Neurosurgery and Rheumatology, both of which employ very high-dose/high-potency steroids more frequently in their day-to-day practice.  

Luckily the reaction is self-limiting, and there are various medications that can help curtail the length of the misery such as Reglan, Baclofen, and Thorazine, though often it takes several trial and errors to find an efficacious one for each individual. At this time, no literature exists regarding the percent success rate of the old “drink out of the topside of the cup” though.