Cisplatin hypomagnesemia with

Beilin SL, Sehm M. Cisplatin-induced hypomagnesemia with seizures a case report and review of the literature. Gynecol Oncol 1988 30(1) 104-13. 

Hypomagnesemia is usually associated with disorders of the intestinal tract or kidneys. Drugs (e.g., aminoglycosides, amphotericin B, cyclosporine, diuretics, digitalis, cisplatin) or conditions that interfere with intestinal absorption or increase renal excretion of magnesium can cause hypomagnesemia. 

Lam M, Adelstein DJ (1986) Hypomagnesemia and renal magnesium wasting in patients treated with cisplatin. Am J Kidney Dis 8 164-169... 

Amphotericin-induced hypomagnesemia may be more profound in patients who develop a divalent cation-losing nephropathy associated with cisplatin (12). 

Ocular toxicity of cisplatin has been reported in a 47-year-old woman who experienced rapid uncontrollable eye movements associated with hypomagnesemia and hypocalcemia in the presence of renal tubular damage (123). 

Renal magnesium wasting is the main mechanism responsible for the hypomagnesemia associated with cisplatin (172), and it can be associated with enhanced tubular reabsorption of calcium and consequent hypocalciuria (173). This dissociation in the renal handling of calcium and magnesium is similar to what is found in Bartter s syndrome. The site of the renal tubular defect in these conditions is not known, but there is evidence that active renal tubular transport systems are disrupted. 

Hypomagnesemia secondary to cisplatin administration can be severe enough to present as generalized seizures (172). It more commonly presents with muscular weakness, tremulousness, peripheral paresthesia, tetany, and personality changes. It is dose-related and schedule-related. Loss of magnesium can be prevented by prophylactic magnesium infusion before and during cisplatin administration (177), but this is not universally recommended because of the risk of acute uremia (178). 

Gonzalez C, Villasanta U. Life-threatening hypocalcemia and hypomagnesemia associated with cisplatin chemotherapy. Obstet Gynecol 1982 59(6) 732. ... 

Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynaud s phenomenon in patients treated with cisplatin, vinblastine, and bleomycin. Cancer 1985 56(12) 2765-70. 

Markman M, Cleary S, Howell SB. Hypomagnesemia following high-dose intracavitary cisplatin with systemically administered sodium thiosulfate. Am J Chn Oncol 1986 9(5) 440-3. 

Acute renal failure due to cisplatin therapy is usually partially reversible with time and supportive care, including dialysis. Serummag-nesium concentrations should be monitored frequently and hypomagnesemia corrected (see Chap. 50). Hypocalcemia and hypokalemia may be difficult to reverse until hypomagnesemia is corrected. Progressive chronic kidney disease due to cumulative toxicity may not be reversible and in some cases may require chronic dialysis support. 

Magnesium is less commonly measured in toxicological studies and clinical medicine despite several compounds, such as cyclosporin and cisplatin, which have marked effects on magnesium homeostasis (Borland et al. 1985 Evans 1988), and cisplatin (Magil et al. 1986 Yao et al. 2007). Hypomagnesemia is often associated with myopathies. 

Hypomagnesemia has been associated with more than 50 drugs, especially those that are nephrotoxic, including cisplatin, aminoglycoside antibiotics, cyclosporine, and amphotericin B. Secondary hypocalcemia and hypokalemia may result with myasthenia and tetany (Swaminathan 2003). 

Flombaum CD. Hypomagnesemia associated with cisplatin combinati[Pg.620]

Decreased magnesium levels, that is, levels of 1.2 mEq/L (0.64 mmol/L) or less, may be noted in patients with conditions that cause excessive urinary loss of magnesium, including poorly controlled diabetes and alcohol abuse, or in patients using drugs such as loop and thiazide diuretics (e.g., Lasix, Bumex, Edecrin, and hydrochlorothiazide), cisplatin (which is used widely to treat cancer), and the antibiotics gentamicin, amphotericin, and cyclosporine. Hypomagnesemia also can... 

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