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Sodium, potassium, calcium, bicarbonate, da ma'auni na ruwa a cikin jini sune ginshiƙi don kiyaye ayyukan ilimin lissafi a cikin jiki. An sami rashin bincike kan rashin lafiyar magnesium ion. Tun farkon shekarun 1980, an san magnesium a matsayin "electrolyte da aka manta". Tare da gano takamaiman tashoshi na magnesium da masu jigilar kayayyaki, da kuma fahimtar tsarin ilimin lissafi da tsarin hormonal na magnesium homeostasis, fahimtar mutane game da rawar da magnesium a cikin magungunan asibiti yana zurfafa koyaushe.

Magnesium yana da mahimmanci ga aikin salula da lafiya. Magnesium yawanci yana wanzuwa a cikin nau'in Mg2+, kuma yana samuwa a cikin dukkan kwayoyin halitta, daga tsire-tsire zuwa manyan dabbobi masu shayarwa. Magnesium abu ne mai mahimmanci ga lafiya da rayuwa, kamar yadda yake da mahimmancin ma'auni na tushen makamashin salula ATP. Magnesium galibi yana shiga cikin manyan hanyoyin ilimin halittar jiki na sel ta hanyar ɗaure ga nucleotides da daidaita ayyukan enzyme. Duk halayen ATPase suna buƙatar Mg2+- ATP, gami da halayen da suka shafi RNA da ayyukan DNA. Magnesium shine mai haɗin gwiwar ɗaruruwan halayen enzymatic a cikin sel. Bugu da ƙari, magnesium kuma yana daidaita glucose, lipid, da furotin metabolism. Magnesium yana da hannu wajen daidaita aikin neuromuscular, daidaita yanayin bugun zuciya, sautin jijiyoyin jini, ɓoyewar hormone, da sakin N-methyl-D-aspartate (NMDA) a cikin tsarin juyayi na tsakiya. Magnesium shi ne manzo na biyu da ke da hannu a cikin siginar ciki da kuma mai kula da kwayoyin halitta na rhythm na circadian wanda ke sarrafa hawan circadian na tsarin nazarin halittu.

Akwai kusan g 25 na magnesium a cikin jikin mutum, galibi ana adana shi a cikin ƙasusuwa da kyallen takarda. Magnesium muhimmin ion cikin salula ne kuma mafi girma na biyu mafi girma a cikin salula bayan potassium. A cikin sel, 90% zuwa 95% na magnesium yana ɗaure ga ligands irin su ATP, ADP, citrate, proteins, da acid nucleic, yayin da kawai 1% zuwa 5% na magnesium intracellular ya wanzu a cikin kyauta. Ma'aunin magnesium na cikin salula na kyauta shine 1.2-2.9 mg/dl (0.5-1.2 mmol/L), wanda yayi kama da maida hankali na waje. A cikin plasma, kashi 30% na magnesium da ke yawo yana ɗaure da sunadaran musamman ta hanyar fatty acids kyauta. Marasa lafiya masu tsayin lokaci mai yawa na fatty acids yawanci suna da ƙananan ƙwayoyin magnesium na jini, waɗanda suke da alaƙa da haɗarin cututtukan zuciya da jijiyoyin jini. Canje-canje a cikin fatty acids kyauta, da matakan EGF, insulin, da aldosterone, na iya shafar matakan magnesium na jini.

Akwai manyan gabobin magnesium guda uku: hanji (daidaita abincin magnesium na abinci), kasusuwa (ajiye magnesium a cikin nau'in hydroxyapatite), da kodan (daidaita fitar da magnesium fitsari). Waɗannan tsarin an haɗa su kuma an daidaita su sosai, tare suna samar da axis na koda na gut, wanda ke da alhakin sha, musayar, da fitar da magnesium. Rashin daidaituwa na metabolism na magnesium na iya haifar da sakamako na pathological da physiological

Abincin da ke da wadatar magnesium sun haɗa da hatsi, wake, goro, da kayan lambu masu kore (magnesium shine ainihin ɓangaren chlorophyll). Kusan kashi 30 zuwa 40% na abin da ake ci na magnesium na abin da ake ci yana sha ne ta hanji. Mafi yawan sha yana faruwa a cikin ƙananan hanji ta hanyar jigilar salula, wani tsari mai wuce gona da iri wanda ya haɗa da matsewar sel. Babban hanji zai iya daidaita ƙwayar magnesium ta hanyar transcellular TRPM6 da TRPM7. Rashin kunna kwayar halittar TRPM7 na hanji zai iya haifar da rashin ƙarfi a cikin magnesium, zinc, da calcium, wanda ke da lahani ga farkon girma da rayuwa bayan haihuwa. Abubuwan sha na Magnesium suna tasiri da abubuwa daban-daban, ciki har da shan magnesium, ƙimar pH na hanji, hormones (kamar estrogen, insulin, EGF, FGF23, da hormone parathyroid [PTH]), da kuma microbiota gut.
A cikin kodan, tubules na renal suna sake dawo da magnesium ta hanyoyi na waje da na ciki. Ba kamar yawancin ions irin su sodium da calcium, ƙananan adadin (20%) na magnesium ne kawai aka sake dawowa a cikin tubules na kusa, yayin da yawancin (70%) na magnesium an sake dawowa a cikin madauki na Heinz. A cikin tubules na kusa da kuma manyan rassan madauki na Heinz, reabsorption na magnesium galibi ana yin su ne ta hanyar gradients na taro da yuwuwar membrane. Claudin 16 da Claudin 19 sun samar da tashoshi na magnesium a cikin rassan rassan madauki na Heinz, yayin da Claudin 10b yana taimakawa wajen samar da intraluminal intraluminal intraluminal cell cell, yana motsa magnesium ion reabsorption. A cikin tubules mai nisa, magnesium yana daidaita tsarin reabsorption na intracellular (5% ~ 10%) ta hanyar TRPM6 da TRPM7 a tip tantanin halitta, ta haka ne ke ƙayyade ƙayyadaddun ƙwayar magnesium na urinary na ƙarshe.
Magnesium wani muhimmin bangaren kashi ne, kuma kashi 60% na magnesium a jikin dan Adam ana adana shi a cikin kasusuwa. Magnesium ɗin da za a iya musanya a cikin ƙasusuwa yana ba da tanadi mai ƙarfi don kiyaye abubuwan da ke cikin jini na jini. Magnesium yana inganta samuwar kashi ta hanyar rinjayar aikin osteoblasts da osteoclasts. Ƙara yawan shan magnesium na iya ƙara yawan ma'adinan kashi, don haka rage haɗarin karaya da osteoporosis a lokacin tsufa. Magnesium yana da rawar biyu wajen gyaran kashi. A lokacin mummunan lokaci na kumburi, magnesium na iya inganta maganganun TRPM7 a cikin macrophages, samar da cytokine da ke dogara da magnesium, da kuma inganta microenvironment na rigakafi na kasusuwa. A lokacin ƙarshen gyaran gyare-gyare na gyaran kashi, magnesium zai iya rinjayar osteogenesis kuma ya hana hazo hydroxyapatite. TRPM7 da magnesium kuma suna shiga cikin tsarin ƙididdiga na jijiyoyi ta hanyar tasiri na sauye-sauye na ƙwayoyin tsoka mai laushi zuwa osteogenic phenotype.

Matsakaicin ƙwayar magnesium na al'ada a cikin manya shine 1.7 ~ 2.4 mg / dl (0.7 ~ 1.0 mmol / L). Hypomagnesemia yana nufin ƙwayar magnesium ta jini a ƙasa da 1.7 MG / dl. Yawancin marasa lafiya tare da hypomagnesemia na iyaka ba su da alamun bayyanar. Saboda yuwuwar yuwuwar ƙarancin magnesium na dogon lokaci a cikin marasa lafiya tare da matakan magnesium na jini sama da 1.5 mg/dl (0.6 mmol/L), wasu suna ba da shawarar haɓaka ƙananan kofa don hypomagnesemia. Koyaya, wannan matakin har yanzu yana da rigima kuma yana buƙatar ƙarin ingantaccen asibiti. 3% ~ 10% na yawan jama'a yana da hypomagnesemia, yayin da yawan adadin masu ciwon sukari na 2 (10% ~ 30%) da marasa lafiya na asibiti (10% ~ 60%) sun fi girma, musamman ma a cikin sashin kulawa mai zurfi (ICU), wanda adadin abin da ya faru ya wuce 65%. Yawancin binciken da aka gudanar ya nuna cewa hypomagnesemia yana da alaƙa da haɗarin haɗari na duk-mutuwar mace-mace da cututtukan cututtukan zuciya.

Bayyanar cututtuka na hypomagnesemia sun haɗa da alamun da ba su da takamaiman irin su barci, ƙwayar tsoka, ko rauni na tsoka wanda ya haifar da rashin isasshen abinci, ƙara yawan asarar gastrointestinal, rage reabsorption na koda, ko sake rarraba magnesium daga waje zuwa cikin sel (Figure 3B). Hypomagnesemia yawanci yana tare da sauran cututtukan lantarki, gami da hypocalcemia, hypokalemia, da alkalosis na rayuwa. Sabili da haka, ana iya yin watsi da hypomagnesemia, musamman a yawancin saitunan asibiti inda ba a auna matakan magnesium na jini akai-akai. Sai kawai a cikin hypomagnesemia mai tsanani (maganin magnesium <1.2 MG / dL [0.5 mmol / L]), bayyanar cututtuka irin su rashin daidaituwa na neuromuscular (ƙwaƙwalwar wuyan hannu, farfadiya, da rawar jiki), cututtuka na zuciya da jijiyoyin jini (arrhythmias da vasoconstriction), da kuma rashin lafiya na rayuwa (juriya na insulin da ƙwayoyin cuta). Hypomagnesemia yana hade da karuwar asibiti da yawan mace-mace, musamman ma lokacin da hypokalemia ke tare da shi, yana nuna mahimmancin asibiti na magnesium.
Abubuwan da ke cikin magnesium a cikin jini suna da ƙasa da 1%, don haka abun ciki na magnesium na jini ba zai iya dogaro da gaske ya nuna jimlar magnesium a cikin nama ba. Bincike ya nuna cewa ko da ma'aunin sinadarin magnesium ya zama al'ada, abun ciki na magnesium na cikin salula na iya raguwa. Sabili da haka, la'akari kawai abun ciki na magnesium a cikin jini ba tare da la'akari da cin abinci na magnesium na abinci da asarar fitsari ba na iya yin la'akari da rashi na magnesium na asibiti.

Marasa lafiya tare da hypomagnesemia galibi suna fuskantar hypokalemia. Hypokalemia mai taurin kai yawanci ana danganta shi da rashi na magnesium, kuma ana iya gyara shi da kyau bayan matakan magnesium sun dawo daidai. Rashin ƙarancin magnesium na iya haɓaka fitowar potassium daga magudanar tarawa, yana ƙara tsananta asarar potassium. Rage matakan magnesium na ciki na ciki yana hana ayyukan Na + - K +- ATPase kuma yana ƙara buɗe tashoshi na potassium medullary (ROMK), wanda ke haifar da ƙarin asarar potassium daga kodan. Haɗin kai tsakanin magnesium da potassium kuma ya haɗa da kunna sodium chloride co transporter (NCC), don haka inganta haɓakar sodium. Rashin Magnesium yana rage yawan NCC ta hanyar E3 ubiquitin protein ligase da ake kira NEDD4-2, wanda ke rage tsarin ci gaban kwayoyin halitta na neuronal, kuma yana hana NCC kunnawa ta hanyar hypokalemia. Ci gaba da rage ka'idojin NCC na iya haɓaka jigilar Na + nesa a cikin hypomagnesemia, wanda ke haifar da haɓakar ƙwayar potassium ta fitsari da hypokalemia.

Hypocalcemia kuma yana da yawa a cikin marasa lafiya da hypomagnesemia. Rashin Magnesium na iya hana sakin hormone parathyroid (PTH) kuma ya rage hankalin kodan zuwa PTH. Rage matakan PTH na iya rage reabsorption na calcium na koda, ƙara yawan ƙwayar calcium na fitsari, kuma a ƙarshe ya haifar da hypocalcemia. Saboda hypocalcemia wanda hypomagnesemia ke haifar, hypoparathyroidism sau da yawa yana da wuya a gyara sai dai idan matakan magnesium na jini ya dawo daidai.

Jimlar jimlar ma'aunin magnesium shine daidaitaccen hanya don tantance abun ciki na magnesium a aikin asibiti. Zai iya tantance canje-canje na ɗan gajeren lokaci a cikin abun ciki na magnesium, amma yana iya raina jimillar abubuwan magnesium a jiki. Abubuwan da ke tattare da endogenous (kamar hypoalbuminemia) da abubuwan da ba su da kyau (kamar samfurin hemolysis da anticoagulants, irin su EDTA) na iya shafar ƙimar ma'aunin magnesium, kuma waɗannan abubuwan suna buƙatar la'akari yayin fassarar sakamakon gwajin jini. Hakanan ana iya auna sinadarin magnesium ionized, amma fa'idar aikin sa na asibiti bai bayyana ba tukuna.
Lokacin bincikar hypomagnesemia, yawanci ana iya ƙayyade dalilin bisa tarihin likitancin majiyyaci. Duk da haka, idan babu wani dalili mai mahimmanci, ana buƙatar amfani da takamaiman hanyoyin bincike don bambance ko asarar magnesium ta haifar da koda ko gastrointestinal tract, irin su 24-hour magnesium excretion, magnesium excretion juzu'i, da gwajin nauyin magnesium.

Kariyar Magnesium sune tushe don magance hypomagnesemia. Duk da haka, a halin yanzu babu takamaiman jagorar jiyya don hypomagnesemia; Sabili da haka, hanyar magani ya dogara ne akan tsananin alamun asibiti. Za a iya maganin hypomagnesemia mai sauƙi tare da kari na baki. Akwai shirye-shiryen magnesium da yawa akan kasuwa, kowannensu yana da ƙimar sha daban-daban. Gishirin halitta (kamar magnesium citrate, magnesium aspartate, magnesium glycine, magnesium gluconate, da magnesium lactate) sun fi sauƙin sha a jikin ɗan adam fiye da gishirin inorganic (kamar magnesium chloride, magnesium carbonate, da magnesium oxide). Sakamakon gama gari na kari na magnesium na baka shine zawo, wanda ke haifar da ƙalubale don ƙara ƙarin magnesium na baka.
Don lokuta masu banƙyama, maganin ƙwayoyi na adjuvant na iya zama dole. Ga marasa lafiya tare da aikin koda na al'ada, hana tashoshi na sodium na epithelial tare da aminophenidate ko triaminophenidate na iya ƙara yawan matakan magnesium na jini. Sauran dabarun da za a iya amfani da su sun haɗa da amfani da masu hana SGLT2 don ƙara yawan matakan magnesium na jini, musamman a cikin marasa lafiya da ciwon sukari. Hanyoyin da ke bayan waɗannan tasirin ba a bayyana su ba tukuna, amma suna iya kasancewa suna da alaƙa da raguwar ƙimar tacewar glomerular da ƙaruwar sake absorption na tubular na koda. Ga marasa lafiya tare da hypomagnesemia wadanda ba su da tasiri a cikin maganin maganin maganin magnesium na baka, irin su wadanda ke da gajeren hanji, ciwon hannu da ƙafa, ko farfaɗiya, da kuma wadanda ke da rashin lafiyar hemodynamic wanda ya haifar da arrhythmia, hypokalemia, da hypocalcemia, ya kamata a yi amfani da maganin jijiya. Ana iya inganta hypomagnesemia da PPI ke haifarwa ta hanyar sarrafa inulin ta baki, kuma tsarinsa na iya kasancewa yana da alaƙa da canje-canje a cikin microbiota na hanji.

Magnesium abu ne mai mahimmanci amma sau da yawa ba a kula da shi a cikin ganewar asibiti da magani. Ba kasafai ake gwada shi azaman electrolyte na al'ada ba. Hypomagnesemia yawanci ba shi da alamun bayyanar. Kodayake ainihin hanyar daidaita ma'aunin magnesium a cikin jiki ba a bayyana ba tukuna, an sami ci gaba a cikin nazarin tsarin da kodan ke sarrafa magnesium. Yawancin kwayoyi na iya haifar da hypomagnesemia. Hypomagnesemia ya zama ruwan dare a tsakanin marasa lafiya na asibiti da kuma haɗarin haɗari na tsawan lokaci na ICU. Ya kamata a gyara hypomagnesemia a cikin nau'i na shirye-shiryen gishiri na kwayoyin halitta. Ko da yake har yanzu akwai asirai da yawa da za a warware game da rawar da magnesium ke takawa wajen kiwon lafiya da cututtuka, an sami ci gaba da yawa a wannan fanni, kuma ya kamata likitocin asibiti su mai da hankali sosai kan muhimmancin magnesium a cikin magungunan asibiti.