von Ehrlich B1
Question: Frequent requests concerning practical execution of parenteral magnesium therapy are evidence of increasing interest in this therapy. Materials/method:Our presententation is based on over 1200 parenteral magnesium-infusions in 71(43f/29m) patients 18 to 85 years of age. Retrospective analysis reveals 21 main indications and a major number of overlapping symptoms/ indications, which all where associated with documented magnesium-depletion. Oral Mg-therapy was preceeding and concomitant in all cases – parenteral therapy was “ad-on” to achieve the respective therapeutical aim: the reduction/improvement of symtoms associated with magnesium depletion. Results: Sequence of indications due to patient numbers: migraine 17 (migraine in pregnancy 1); depression 14; tinnitus 7; psychophysical exhaustion 7; oncological concomitant or follow up therapy (rituximab,sunitinib,cisplatin-nephropathy caused magnesium depletion) 6; poly-neuropathy 5; chronic pain 3; panic syndrome 3; atrial fibrillation onset 2; and casuistic: epilepsia;fibromyalgia;alcohol-dependence; myocardial-failure, beginning dementia, Parkinson syndrome, anxiety syndrome, asthma bronchiale exacerbation, bipolar disorder, diabetes mellitus, myalgia. Categorizing the therapies by our setting-importance: I) tumor concomitant or follow up :n=365 infusions II) depression/Exhaustion III) pain/neuropathy. In migraine and psychiatric patients compliance is often bad in spite of already positive evidence in controlled studies. Therapy results – naturally respecting the casuistic approach –where,in cases of compliance, almost without exception positive. Procedure: Requirement for our approach was Magnesium-depletion in spite of oral Mg-therapy. Pathophysiological and scientific basis of each individual treatment approach where thoroughly discussed with the patient and documented. With strict regard of the necessary precautions we had no relevant complications. Pretests: ecg,RR,HR,lab: creatinine, mg, ca, k in serum. Exclusion criteria: av-block, bradycardia, symptomatic hypotension, acute pulmonal congestion therapy: 3,2mmol Mg increasing by step to 6,4 and 8mmol Mg per day (=4ml of 10ml ampule Magnesiumsulfate iv 50% containing 20mmol) each ad 100ml NaCl 0,9% . Preparation sterile precautions. Infusion time 30-40 min. Permanent survey by pulse-oxymetry with alarm function and contact with medical staff. Alternatively 5% glucose carrier is possible. Higher infusion volumes namely NaCl should be avoided because of high NaCl-load. Particularly in patients with heart failure we reduce to smaller volume of 50ml carrier solution. Higher magnesium dosage up to 10ml per session in suitable patients over accordingly prolonged infusion time. More than this seems not suitable for this ambulant setting. Patients are instructed to sit up slowly, rest for 10 minutes and blood pressure is controlled before leaving. Parenteral Magnesium-ad-on-therapy is due to our experience an underestimated positive therapy option for many indications of internal medicine.