I am a 40 yrs. old working woman I suffers from diarrhoea and vomiting for a long period but now I have developed tremors, depression, confusion and sometimes hallucinations. For this problem I consulted a physician, after taking history and on the basis of symptoms and investigations physician diagnosed me as a case of magnesium deficiency. I want to know about this problem in detail.

Disorders of magnesium metabolism are occasionally responsible for otherwise puzzling clinical features and are susceptible to therapeutic control. The most frequent cause of magnesium deficiency is prolonged diarrhoea or vomiting, which has been treated with parenteral fluid without magnesium supplements. It is associated with chronic diarrhoea and severe undernutrition, such as occurs in protein-energy malnutrition and the malabsor­ption syndrome. Uncontrolled diabetes mellitus, aldosteronism, hyperpara­thy­roidism, the diuretic phase of acute renal failure and chronic alcoholism lead to magnesium deficiency from excessive urinary loss. It occasionally follows on continued diuretic therapy. Clinical features are predominantly neuromuscular with tremor, choreiform movements and aimless plucking of the bedclothes. Mental depression, confusion, agitation, epileptiform convulsions and hallucinations also occur. The diagnosis can be confirmed by finding the concentration of magnesium in the plasma to be less than 0.75 m mol/L. Magnesium deficiency is best treated parenterally 50 m mol of magnesium chloride may be added to 1 litre of 5 percent glucose or other isotonic solution and given over a period of 12 to 24 hours. The infusion should be repeated daily until the plasma concentration remains within the normal range.

My mother is about 70 yrs old, since last two to three years she is suffering from pain in the back, sometimes generalised pain and sometimes a sharper pain of sudden onset. Her body has bent forward. We have consulted on orthopedic surgeon, he told us that she is suffering from senile osteoporosis.   I want your opinion about the disease.

Senile osteoporosis is characterised by diffuse osteoporosis of unknown cause. It affects the elderly, especially women but it may be seen also in patients of middle age. It may possibly have an endocrine basis. The whole skeleton is affected but the changes in the spine are more obvious than those elsewhere. There is a reduction of total bone mass compressing fracture of one or more of the vertebral bodies is liable to occur from only trivial violence. Even without fracture the thoracic vertebrae tend gradually to become wedge shaped so that the spine bends forward to produce a rounded kyphosis. The long bones are also prone to fracture easily. The patient is often a woman of over 60. The osteoporosis may be symptomless and may be found only by chance. In other cases there is pain in the back. The pain occurs in two forms, a mild generalised ache and a sharper pain of sudden onset, denoting a compression fracture. Examination reveals a rounded kyphosis in the thoracic region. The trunk is shortened and there is a transverse furrow across the abdomen. X-Ray shows the reduced density of the vertebral bodies, which become concave at their upper and lower surfaces from pressures of the intervertebral discs. Metabolic balance studies may show a negative calcium balance. Treatment is rather unsatisfactory. It may be possible to restore the patient to positive calcium balance by calciums supplements to the diet but the gain is usually small and a dramatic improvement in the radiographic appearance cannot be expected. In the belief that the disorder has an endocrine basis oestrogen and androgen therapy has been used but with doubtful benefit. If back pain is troublesome a light spinal brace should be prescribed.

I am 25 yrs old woman and have five months pregnancy. From the beginning of pregnancy I am suffering from watery vaginal discharge. I want your opinion about this problem.

A watery vaginal discharge is uncommon, apart from obvious causes such as urinary fistulae where the high urea contents of the discharged fluid is diagnostic. Discharges of this kind have been described in the condition known as hydrops tubae profluens when a hydrosalpinx has been supposed to discharge its contents through the interstitial portion of the tube into the cavity of uterus. In carcinoma of the fallopian tube the discharge has been aptly described as amber coloured. During pregnancy a watery discharge is more frequent. In hydrorrhoea gravidarum the watery discharge is probably due to leakage of the liquor amnii through rupture of the membranes above the level of the internal os.

I am a 50 years old lady, last year I developed small, slightly elevated and blue black lesions on my hands. I consulted a skin specialist. He told me that you are suffering from blue nevi. Skin specialist told me that if these lesions are growing or may feel any change in the lesions than it has to be evaluated to rule out cancer. What is your opinion?

Blue navi are small, slightly elevated and blue-black lesions. They are common in persons of Asian descent and an individual patient may have several of them. If present without change for many years, they may be considered benign (Non Cancerous), since malignant (cancerous) blue nevi are rare. However blue black papules and nodules that are new or growing must be evaluated to rule out nodular melanoma (Cancer).