The patient admitted that he was not eating vegetables at all. Instead, his diet was based upon pizza, chips, and soft drinks.
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
F. Suggest a long-term management plan for this patient to prevent future episodes.
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Exercise (the pt plays handball and swimming) can contribute to hypomagnesemia ( increases urinary and sweat losses)
Should encourage normal diet containing vegetables and fruits which contains Mg as well as K.
diet could lead to mg renal losses
balanced diet , reduced soft drinks
1- exercise
2- mg rich diet
Diest based on pizza and soft drinks, not eating vegetables etc., has an effect by deficiency of magnesium in nutrients. encouraging of food rich in diet is essential
Alcoholism
Proton pump inhibitors
Exercise-induced sweating
Hyperaldosteronism
Bartter and Gitelman syndromes
Loop and thiazide diuretics
Plan
oral magnesium salts such as magnesium oxide (250 to 500 mg four times daily) can be used for repletion, but these substances frequently cause diarrhea, particularly at high doses.
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Again- I feel I don’t have enough information about this patient background history and results of recommended labs.
Mg plays an essential role in the regulation of glucose metabolism, insulin sensitivity, and insulin secretion.
High carbs diet and refined sugars stimulate insulin secretion, which increases urinary excretion of Mg, leading to low magnesium levels in the blood. Additionally, a high-carbs diet may also increase the demand for Mg in the body, leading to Mg depletion.
It is important to note that the link between severe hypomagnesemia and high carbs diet is not definitive, and other factors such as kidney disease such as; Gitelman’s disease, bartter syndrome, RTA, alcoholism, and certain medications, like PPI and diuretics, or excessive loss with exercises can also contribute to low magnesium levels.
F. Suggest a long-term management plan for this patient to prevent future episodes.
Mg replacement for now then supplement either though diet or oral tablets.
Model answer approved by the board:
What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Exercise appears to lead to magnesium depletion through alterations in blood magnesium levels as well as increased excretion through sweat and urine, which can be compounded further by inadequate dietary intakes of magnesium (4).
Suggest a long-term management plan for this patient to prevent future episodes.
Encourage magnesium-rich foods, such as green leafy vegetables, meat, seafood, nuts (1).
E- starvation, alcohol, vomiting., diarrhea and PPI
F- counseling and education
high rich mg food nutritionist involve
avoid factor aggravate loss mg
E- patient might be alcoholic, soft drinks are mainly acidic and might have contributed to loss of Mg
F- Mg rich diet, he may need MgO as tablets
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Starvation.Gastrointestinal causes include low dietary intake of magnesium, reduced gastrointestinal absorption or increased gastrointestinal lossKidney causes involve increased excretion of magnesiumAlcohol use disorder with poor nutritional intake.Critically ill people who cannot take food by mouth and must receive all their nutrients by IV.electrolyte disorders, including hypokalemia and hypocalcemiause of a proton pump inhibitor and concomitant use of diuretics. Amphotericin B F. Suggest a long-term management plan for this patient to prevent future episodes.
Mg – rich diet
Monitor magnesium level daily.
Depends on how mild or severe it is and the underlying cause
If the hypomagnesemia is mild, recommend magnesium tablets taken by mouth
If the hypomagnesemia is severe, you’ll likely be in a hospital and receive fluids and magnesium through an IV
Review of his medicine
What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Alcohol consumption
Drugs like PPi and diuretics
Vomiting
Diarrhea
Starvation
Suggest a long-term management plan for this patient to prevent future episodes.
Mg – rich diet
Manage the cause
Review of his medicine
What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Suggest a long-term management plan for this patient to prevent future episodes.
1-Education of the patient about balanced diet containing all elements and stop alcohol.
Green vegetables such as spinach are good sources of magnesium, which is contained in the chlorophyll molecule. Some legumes (beans and peas), nuts and seeds, and whole, unrefined grains are also good sources of magnesium.
Aggrevating:
Management;
E)drugs or alcoholism
F)mg rich diet and review his medication
E: Other GIT diseases:
Protein-calorie malnutrition
Starvation
Chronic alcoholism
Diarrhoea
Previous bowel resection
Drug use:
Laxative abuse
Chronic Alcoholism
Diuretic use
PPI use
Recent antibiotic use
Endocrine disorders
Hyperthyroidism
Recent parathyroidectomy resulting in Hungry-Bone Syndrome
DKA
Hyperaldosteronism
F: Identify rectifiable conditions or states
Refer to a dietician: for Mg-rich foods
He is having hypoMg due to a poor diet of Mg content.
we need to be sure that he is not taking PPI which id causing hypomagnseamia.
E- decreased intake and protein caloric malnutrition
Chronic alcoholism,
Diarrhea, drugs
F- dietary assessment and advice balanced diet
Review of medications
Mg supplement
E. Aggravated factor for patient low magnesium diet alcohol consumption and must revise his medication like ppi and if have history of dihrhea.
F. Long term management plane advice change diet happit and take proper food containg mg avoid medication causing hypomagnesemia avoid alcohol and control underlying cause
E. Low Mg diet,
use of drugs like diuretic, Proton pump inhibitor
F. Dietary advice, Mg supplements
Factors that aggravate negative Mg balance
Long-term management;
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
Hypomagnesemia begins to occur after a relatively small Mg deficit because there is little rapid exchange of extracellular Mg with the much larger bone and cell stores.
Factors aggravating negative Mg balance include alcohol and medications like PPI and diuretics.
F. Suggest a long-term management plan for this patient to prevent future episodes.
E. Alcohol, drugs like diuretics, laxative, PPI.
Condition like diarrhea
History of surgery with malabsorption like short bowl syndrome
Rare kidney condition like gilteman syndrome
Disease like Diabetes, injections of insulin.
F. He need balanced diet, may be vitamin intake to consider. Dietician support
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
excessive use of loop diuretic,
PPI
Chronic alcoholism
diarrhea.
F. Suggest a long-term management plan for this patient to prevent future episodes.
balanced diet containing the mean constituents including vegetable, animal proteins, carbohydrates, less fats.
.
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
excessive use of loop diuretic, PPI
Refeeding syndrome.
Chronic alcoholism
diarrhea.
F. Suggest a long-term management plan for this patient to prevent future episodes.
Refer him to a dietician to provide him with a high-Mg and K diet. provide him with vegetables. avoid medications like loop diuretics or PPI.
Main aggravated the pt.’s negative magnesium balance is malnutrintional status poor diet rich in Mg
many other factors lead to hypomagnesemia as
use of medication as diuretic ( thiazides )
ABG status metabolic acidosis
hypokalemia
Diabetic pt.
Hypercalcemia
antibiotic ( aminoglycoside ) antifungal ( amphotericin ) anti viral ( foscarnet )
chemotherapy agent ( cisplatin ) immunosuppressant drugs ( tacrolimus – cyclosporine)
—long term management plan for this pt.
exclude other cause
evaluate nutritional status and put diet plan for him and follow up .
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
We need t take more history to find out other possibilites
F. Suggest a long-term management plan for this patient to prevent future episodes.
POOR DIET AND SOFT DRINKS ARE THE MOSTLIKLY CAUSE OF HIS ELECTROLYTES IMBALANCE , NEEDS COUNSELING FOR HIS DIET AND AMOUNT OF FLUIED INTAKE AS MORE THAN NEEDED FLUIED CAN AFFECT THE ELECTROLYTES , NEEDS ALSO TO BE KEEPT FOR WHILE ON MAGNESIUM SUPPLEMENTS
. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
decreased intake
protein calorie malnutrition.
starvation ketosis cause renal loss of Mg.
.chronic alcoholism.
diarrhea.
F. Suggest a long-term management plan for this patient to prevent future episodes.
encourage Mg -rich foods as nuts, seafood etc
treatment of diarrhea.
review his medication.
avoid alcohol.
E. What might have aggravated the patient’s negative magnesium balance in addition to his diet?
F. Suggest a long-term management plan for this patient to prevent future episodes.
Nice plan, Agree