ALCOHOLISM patients with alcoholic cirrhosis are reduced.118'11S Attempts
Hypomagnesemia occurs frequently in patients with have been made to correlate the extent of the decrease
alcoholism, either in the presence or in the absence of with the severity of the liver disease However, the
delirium tremens or cirrhosis.93'120'169'176 Because of its occurrence of hypomagnesemia ir alcoholics lacking
known sedative effects magnesium sulfate was used physical or chemical evidence oi impaired hepatic
empirically to treat delirium tremens.l i l a The discovery function suggests that the disturb ance in magnesium
of hypomagnesemia in patients with chronic alcoholism metabolism in patients wit: alcoholism is not necessarily
and delirium tremens,93'120 coupled with the similarity of related to impairec liver function.
signs and symptoms of delirium tremens. and One of the primary mechanisms for magnesiurr
magnesium deficiency in animals, led to the hypothesis depletion in alcoholism may be the direct effect o
that delirium tremens is the direct result of magnesium alcohol on renal excretion of magnesium.172'177-171
deficiency.112'113 Magnesium diuresis occurs without appreciable change
Much of the research carried out on human mag- in renal blood flow or glomerular filtratior of
nesium metabolism over the past decade was stimulated magnesium and is independent of the alcohol induced
by these observations. In man the delineation of the water diuresis. Two mechanisms have beer proposed:
clinical syndrome associated with hypomagnesemia has alcohol affects a tubular mechanism es sential for the
been a direct outgrowth of these early reports. Although resorption of magnesium; or, alcoho increases the
the serum concentration of magnes ium is reduced in production of metabolic intermediate (such as lactate)
many patients with delirium tremens, this finding has with some potential for bindini magnesium as they are
not been universally true. The response of some of these excreted by the kidney. A present no experimental
patients to parenteral magnesium has appeared to be evidence is available ti support either of these
beneficial, but controlled studies of the use of hypotheses. It should b pointed out, however, that
magnesium in the treatment of delirium tremens have alcohol did not increasi magnesium excretion in
not conclusively demonstrated a specific therapeutic several normal persons whi were depleted of
effect.96'172'173 Moreover, hypomagnesemia frequently magnesium experimentally.31
occurs in alcoholics in the absence of delirium tremens. Other factors that can account for excessive mag
In a survey of all patients requiring hospitalization for nesium loss in alcoholics include vomiting am diarrhea,
alcoholism irrespective of its severity, hypomagnesemia which are common in the alcoholic popu lation,
occurred in 25 per cent whereas delirium tremens hyperhydrosis,82 particularly in patients witl delirium
developed in only a few patients.172 No clinical tremens, and hyperaldosteronism in cirrhot ic patients
differences between the alcoholic patients with who have ascites. Inadequate intake c magnesium
hypomagnesemia and those without were observed. The alone would not in all probability ac count for the
lack of correlation of hypomagnesemia in the alcoholic depletion, since marked renal consei vation
population with a neurologic syndrome — either tetany mechanisms are operative, restricting mag nesium losses
or delirium tremens — has also been pointed out.174 to 1 to 2 mEq per day when diet solely deficient in
magnesium are consumed.27'31
The serum concentrations of magnesium in some
*From the Biophysics Research Laboratory, Department of Biological DISEASES OF THE KIDNEY
Chemistry, Harvard Medical School, and the Division of Medical Biology,
Department of Medicine, Peter Bent Brigham Hospital, Boston (address
reprint requests to Dr. Wacker at the Department of Medicine, Peter Bent Ionized magnesium is available for glomeruh
Brigham Hospital, Boston, Mass. 02115). filtration. The tubules reabsorb the major portion (
Original work contained in this review was supported by a venture filtered magnesium "by processes operating no mally at
grant from The Nutrit ion Foundation, Incorporated, and by a grant-in-aid
(HE-07297) from the National Institutes of Health, Public Health or near saturation."180 Whether tubular st cretion plays
Service, United States Department of Health, Education, and Welfare. a part in regulating magnesium home( stasis in man is
still in question.181 Animal studie using the stop-flow
technic demonstrated acth