MrsD - Magnesium problem
 

MrsD (and anyone who knows) -

I have a real puzzler. Over the past year of so I have encountered on three or four occasions a very unsettling reaction to magnesium supplements and decided to take the bull by the horns this morning but I need help with understanding my observations.

This morning was typical to the other times. I awoke at 4:00 AM and fully on by 6:00 AM. Sinemet, beta blocker, ACE inhibitor, multivitamin, extra Bs, ginger, and psyillium. Added a single capsule of magnesium citrate (165 mg). Suggested daily dose per label is three such capsules. Finally, added potassium gluconate to keep the Mg company.

Within minutes I felt a sense of extreme fatigue washing over me so quickly that I almost had to "rush" back to my bed lest I fall to the floor! And the part that has me really concerned is that about an hour into this I experienced some mild respiratory distress! Just enough to prompt me to focus consciously on my breathing while making me glad that I had reduced the dosage.

Finally, after about two hours, the effect? reaction? resolved over about a ten minute period.

Somewhere in that initial period I managed to get my BP. It was 160/106 with a pulse of 62. All fairly typical for me under the circumstances.

I have searched widely for info but there is little on acute negative experience with magnesium. It seems to be universally praised except for a little material on LiveStrong! about possibilities for overdose when using supplements - including respiratory distress. But other than the test sample none is involved here.

If you could share your thoughts I would greatly appreciate it.
-Rick

The most common effect from oral magnesium even with chelates is a laxative action.

Magnesium does also reduce blood pressure.
Was that dose the total weight of one capsule? Or the elemental
magnesium weight? I suspect it was the total weight. Because 3 capsules are the recommended dose. So the amount of magnesium you consumed is quite small actually. Probably 30mg or so.

I will warn you about your ACE inhibitor. I am just recovering from a SEVERE reaction to lisinopril...which took 10 yrs to manifest. ACE inhibitors increase bradykinin in the body, which has to be metabolized away. This is very common in the lungs...hence your shortness of breath, may be a bradykinin reaction. I got drug induced lupus, from that drug, in addition to bradykinin elevation and terrible pain/burning all over. I couldn't hold my breath either. I was throbbing all over, and was very weak, and had joint pain.

The ACE inhibitors result from research into a S.American viper snake venom which paralyzes prey with elevated bradykinin, putting them into shock. So Merck designed a blood pressure drug based on this work from the 1930's. Snake venom... POISON. As soon as I recover from this, I will probably get tested for hereditary angioedema...which can be triggered also by ACE inhibitors. This will involve an immunologist in about 6mons.

With two BP drugs in your cocktail, you should not have a BP of 160/106. This suggests to me you had a stress reaction, cortisol was dumped and your BP went up. I went off my lisinopril which was causing MORE elevations for me because of my reactions to it. Now I am on a very low dose of beta blocker, and my BPs are 130/80 or less each day (I keep a log).

I have to say, each day now (it has been a month) without that ACE inhibitor and I feel 10 yrs younger and so much better! That reaction was brewing a LONG time.

Here is a wiki on bradykinin:
http://en.wikipedia.org/wiki/Bradykinin

People vary in the reactions to ACE drugs, and if you are simmering with one like I was, you can really really suffer.

I'd search more on bradykinin, if I were you. It is a very potent biogenic amine, and can affect the whole body!
Once armed with your information, I'd get off the ACE drug ASAP, with your doctor's supervision.

Some of us on PN have been using topical lotion magnesium with very good success. I can't tolerate the oral, as it upsets my bowel functions too much, and unreliably.

In my long and storied career as a pharmacist I know of 3 people who died by taking ACE inhibitors, all from angioedema.

There is more beneath this rock than I expected. One of the things that prompted my question is the upcoming appointments that I have with my GP as well as my neuro. I have resolved that it is past time to demand some answers to my questions.

One of those questions is "Why is there such an extreme swing in my BP on a typical day?" It has not been unusual to have periods when a typical day will be around 140/100 in the morning and bup to 200/120 in the afternoon! I have journal entries going back over six years of daily "spells" of this! Combined with cognitive features of tunnel vision as though back in a cave plus abrupt episodes of insane urination due to an osmatic response, even I can only repeat "PD" for so long. I may well have it, but there is more there as well.

And I suspect that Laura has it too. We have danced around with what we are calling paralytic paralysis, but is that simply the best name we could come up with?

MrsD, in light of your info on bradykennin, what do you think could account for the following experience which I noted two years ago and which had been going on for at least three years earlier and which eased with the introduction of beta blockers?:

9/20/11 CURRENT SYMPTOMS AND DESCRIPTION OF “ATTACKS”

Nocturia – up approx five times, two hour intervals, one liter/night
Sporadic anxiety/panic awakens 3:00 AM or so, 3 to 4 times per month
In better condition at 3:00 AM than at 6:00 AM
Cramping of left calf and leg upon first awakening. Lasts 30 min
Poor tolerance of cold and heat. The former is recent. Formerly had very high cold tolerance.
Effects of medications are very unstable now. This is recent.
I must eat very sparingly to avoid triggering an “attack” thirty minutes later. These attacks last two to four hours and have the following characteristics-

They come on with a “warning” period of five to fifteen minutes duration.
Parkinson’s medications have zero effect on either preventing or shortening them.
Initial sign is cognitive and is a sense of withdrawal.
Extreme weakness, especially of legs, is initial physical symptom.
Weakness progresses until, at fifteen minutes, it is for all intents and purposes, a state of paralysis. Cannot stand or even type. Muscle tone is zero (just the opposite of PD rigidity). Experience has shown that adrenaline worsens it substantially.
At midpoint (one to two hours), blood pressure has reached as high as 250/200. (Note: It is very difficult to self-test during an attack). At this stage control of bladder is lost and a large amount of urine passes over a thirty minute period.
Recovery begins. Muscle tone remains low unless attempt is made to force use. In that case, rigidity returns.
Course is not affected by skipping medications nor by taking extra. Predictability.
=============================

Oh, gosh....

I can only comment on two of your list.

1) nocturia comes when you have high blood pressure because during the day when you are about...the kidneys shut off.
When you lie down, then the kidneys start working again, and
make lots of urine. Also impaired glucose tolerance may be a factor as well. If you lie down at 2pm, do you urinate right after that? If so, that would be a clue.

2) High pressures as you describe really are dangerous, and are one sign of pheochromatosis. This is a tumor in the body that secrets epinephrine, usually after a stimulus of some kind.
The only treatment is to have it surgically removed.

There can also be disorders of the carotid bodies in the carotid arteries that control blood pressure. But I don't know much detail about them.

There are people with autonomic neuropathies. This may affect blood pressure and/or the heart. There are various tests for this and it is usually an autoimmune disease, or diabetes that causes it.

Thanks MrsD-
You have given me more info in those few paragraphs than my cocky small town medicos have in twelve years. It is long past time that PWP insisted on a team approach to their treatment and egos be damned. Tonight I am at 160/106 and a pulse of 74. I have ridden a roller coaster for the last dozen years with these insane values and alive only because (according to my GP) since my circulatory system was getting a constant stretching.

I don't know if it adds to the data or not, but the highest BP comes just before the sinemet kicks in (i.e. I turn on). Once that occurs the BP drops over about five minutes back to a normal value of 125/85 or so. I had assumed that the spike resulted from the maximized rigidity of the muscles compressing the vascular system. Now I have doubts.

I am wondering now just how much of this is PD and how much is something else. Is there a part of the pattern that could flag the approach of PD, for example? Does the senior vs young onset show up here?

And why do I get stable 120/80 or even less when taking turmeric? Enough so that my GP was concerned that even though it was a textbook value, that the pulse dropping below 60 would cause problems of its own.

So the tumor issue might require surgery but the fact that a minimum dozen years have passed indicates a benign nature if present.

So, how many of you out there really have PD and how many just thought they did. And if I end up cured how in the hell am I going to find a job in this darned economy??:D

During the night, it occured to me that none of the possibilities mentioned thus far would account for an unusual magnesium reaction.

However, I must admit that yesterday was a pretty good one vis-a-vis symptoms. Is there a possible reaction of "magnesium relief" in which some part of me needed the Mg so badly that it temporarily disturbed the equilibrium? After all, after two hours or so I was pretty much at baseline.

-Rick

I thought of another thing... renal artery stenosis.

This however would be more of a constant elevation and not
likely such a swing.

Now, dopamine is a heart stimulant. It is used when people have heart attacks and strokes sometimes. Injectable dopamine.

First ask yourself if you had these spells BEFORE the ACE inhibitor use. If so were they this bad, or lighter?
What was happening to me happened within 2 hrs of taking my dose for the day. Once it was absorbed orally it blasted me.
Since I took my lisinopril at night, this meant I woke up in pain, and burning and generally a mess. When I started to swell up all over...couldn't bend my legs arms, back, I became frightened. There are GI symptoms with bradykinin, of pain, and bloating, and the breathing problems. I was huffing and puffing like I needed to blow of "steam" or something.

Pheochromocytoma, is displaced adrenal tissue that is congenital. The spells of hypertension, will happen when there is any stimulus --sometimes just compression of the mass by bending over. They are small and do not show visibly for the most part or hidden in the adrenals themselves. They are found diagnostically by a test where a dye or tracer is injected and a body scan then done.

Here is an article:
http://en.wikipedia.org/wiki/Pheochromocytoma
Pay attention to the foods... if you avoid those foods, see if you
have fewer spells of the really elevated pressures.

If you can find a nephrologist or endocrinolgist to see, and evaluate you, that would be best I think.