Magnesium deficiency is often associated with refractory hypokalemia (In up to 50% of cases there is concomitant hypomagnesemia).
WHY? Exact mechanism isn’t known for certain.
PROPOSED MECHANISM: Low intracellular magnesium causes renal wasting of potassium. Normally magnesium will inhibit Renal Outer Medullary Potassium (ROMK) channels in the kidneys; however, hypomagnesemia allows the ROMK channel to efflux K+ into the urine.
NOTE: High Na+ uptake/ aldosterone states may also cause K+ loss (see image).
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