, Volume 17, Issue 7, pp 612-618

Primary hypomagnesemia with secondary hypocalcemia, diarrhea and insensitivity to parathyroid hormone

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That diarrhea may be associated with hypomagnesemia and/or hypocalcemia is clearly shown by the relationship of magnesium, calcium and gut function in a 2-month-old male hospitalized with seizures, diarrhea, anasarca, hypoalbuminemia, hypocalcemia and hypomagnesemia. Calcium, phosphorus, sodium, potassium and nitrogen balances were positive, but magnesium balance was negative with fecal excretion approximating oral intake. Urinary protein loss was 40 mg/24 hr;51Cr albumin loss was 1.8%. Administration of parathyroid hormone during magnesium depletion did not produce any rise in serum calcium, but a normal response was observed after magnesium repletion. All clinical abnormalities cleared when magnesium was given, first parenterally and later orally. Thus, hypomagnesemia appears to have resulted from a selective defect in magnesium absorption. Hypocalcemia resulted from parathyroid hormone unresponsiveness during magnesium deficiency. No explanation for diarrhea, other than hypomagnesemia and/or hypocalcemia, was found. The presence of hypoalbuminemia in the face of a positive nitrogen balance suggests that albumin was not synthesized at its usual rate while the patient was depleted of magnesium.