The Influence of Hypermagnesemia on Serum Calcium and Parathyroid Hormone Levels in Human Subjects

Abstract

We measured serum concentrations of calcium and parathyroid hormone in seven pregnant women who were receiving intravenous magnesium sulfate for the suppression of premature labor. After administration of magnesium sulfate, the mean (±S.E.M.) serum magnesium level rose rapidly from the normal base-line level of 2.0±0.2 mg per deciliter to 6.1±0.4 mg per deciliter (0.8±0.1 to 2.5±0.2 mmol per liter) (P<0.001) at 30 minutes and remained markedly elevated. Concentrations of total and ionized calcium fell gradually in all subjects from normal base-line concentrations, 8.6±0.2 and 4.4±0.1 mg per deciliter (2.2±0.1 and 1.1±0.03 mmol per liter), respectively, into the hypocalcemic range, reaching a nadir of 7.6±0.2 and 3.9±0.1 mg per deciliter (1.9±0.1 and 0.98±0.03 mmol per liter), respectively, at three hours (P<0.001). Parathyroid hormone levels fell rapidly in response to magnesium infusion, from 13.1±2.5 to 7.8±0.7 pg per milliliter at 30 minutes, and were significantly below base-line levels for two hours despite frank hypocalcemia. These results suggest that hypermagnesemia rapidly decreases the secretion of parathyroid hormone in vivo in human subjects and that parathyroid hormone levels remain depressed despite concomitant hypocalcemia. The results also suggest that the hypocalcemia associated with hypermagnesemia may be due in part to the suppressive effects of hypermagnesemia on parathyroid hormone secretion. (N Engl J Med 1984; 310: 1221–5.)