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Crohn's Disease Forum » Treatment » Imuran/Azathioprine/6-MP » Help please impossible. Azathioprine and Mineral Deficiencies


08-14-2013, 11:37 AM   #1
Trish22
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Location: Solihull, United Kingdom
Help please impossible. Azathioprine and Mineral Deficiencies

Hello everyone, it's Trish, have been posting in the Surgery column but now have a problem ,could someone please give advice if possible,Had surgery 5 weeks ago,I ts been a struggle,it being my fourth bowel op,had a Ileo colonic resection,have now only got 1.4 metre of small bowel left, last week my IBD nurse said my bloods were improving and I have started back on my 100mg of azathioprine,so having weekly bloods,Today IBD Nurse rang and said my Magnesium was urgently low, did not even mention my potassium being low at 2.8 as well,think she may have been concerned about Magnesium levels,Anyhow she faxed results through to my GP for urgent prescription to start this afternoon,my GP rang earlier and said could not prescribe as Magnesium is not licensed,so she has sent back a message to my IBD Nurse,She said I will have to have Sanda K,but I know this is only for potassium,I am getting that much Diarrheao ,I am losing both of these minerals,also I think it may be this short bowel syndrome,if this is the case,I am dreading my life,it's hard enough at the moment feeling like I do,with having problems with all my vitamins and minerals,any ideas please,especially regarding Magnesium. thanks Trish x
08-14-2013, 11:50 PM   #2
Catherine
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Sorry no advise.

I think DustyKat's Matt maybe taking Magnesium.

Hopefully she will see this tag.
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Catherine
Mother of Sarah dx aged 16, Jan 2012
DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)
08-15-2013, 01:48 AM   #3
SarahD
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Location: Cambridge, United Kingdom
I found some info on Derby Hospitals website (bottom of page 3) saying that "Magnesium glycerophosphate tablets are unlicensed but are available in
pharmacy on a named patient basis". So you must be able to get them. Perhaps ask at your local pharmacy for advice on how to get some if your GP isn't being helpful? If your levels of magnesium are severely low then it can also be administered in hospital through an IV.

Potassium and magnesium (and calcium) work together, so sometimes both are needed to bring levels back up into the normal range. I suffer from low potassium (2.8 was my lowest and I felt dreadful!) but it was caused by taking Prednisolone. I'm not sure if you're taking pred along with Aza but if so it is another potential cause to look at.

It's probably also worth trying to address the problem of having diarrhea. If that's the route cause of the low magnesium and potassium then you'll need to keep taking magnesium and potassium supplements until the D is resolved, so perhaps discuss this with your IBD nurse to try to find a longer term solution? If it is due to surgery then maybe it'll just take time, but if it's inflammation then this can be treated. I know some people on the forum take phsyllium for D but I don't have any experience with it so can't really say much more. Having a shortened bowel obviously doesn't help, but if you can slow down the transit time of food (and eat foods high in magnesium and potassium) then it should help.

I hope you manage to get something sorted. When my potassium level was 2.8 my GP told me it was the lowest level he'd seen all year. I felt so dreadful I was actually signed off work for a week and I'm the kind of person who usually just keeps on going despite feeling really unwell. Let us know if you manage to get hold of some magnesium.

Sarah
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Symptoms from the age of 12. Mis-diagnosed with UC at the age of 13, and later diagnosed with Crohn's in January 2012 at 24 years old. Disease mainly in terminal ileum.


Current meds:
Azathioprine, Allopurinol, Calcichew D3-Forte, Fortijuice, Alendronic acid, Ranitidine

Previous meds:
Augmentin, Doxycycline, Lansoprazole, Asacol, Pentasa, Prednisolone, Entocort, Cipro, Flagyl, Elemental Extra 028
08-15-2013, 05:13 AM   #4
Trish22
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Join Date: Aug 2012
Location: Solihull, United Kingdom
Thanks Sarah for your valuable advice, had a phone call this morning and am awaiting a bed today in hospital as I need Pottasiums and Magnesiums put through IV as it is now dangerously low,I have been awake most of the night with electric shocks going through calves of my legs in the muscles,also persistent pins and needles in my hands and feet, really scary!I will see if they can suggest, slowing down the D,to prevent this happening,even if it means loperamide or the like to help me.I am on Aza only,and of course B12 every 13 weeks by injection.
Again thanks for our advice ,you have been really helpful, I am having Bloods done every week at present due to the re introduction of the Aza after my surgery,so it's a good job really,asi would not have known till my monthly bloods. Trish x
08-15-2013, 05:39 AM   #5
DustyKat
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Location: New South Wales, Australia
Hey Trish,

Both of my children have had issues with low potassium when flaring but have not had issues post operatively, they have not however had the amount of bowel removed that you have.

My kids have issues with bile salt malabsorption diarrhoea and use psyllium with great effect to control it. I don't know though if it would work for you given the short bowel syndrome that you have but it may be worth asking about.

The vitamin/minerals that I have checked on a regular basis and supplement accordingly are:

Iron Stores
B12
Vitamin D
Magnesium
Zinc

These tests are not normally included in general run of the mill bloods.

My son does take a Magnesium supplement and David has provided very good information about it on the forum. Have a look at Matt's thread as there are some fab links and info on this page regarding Magnesium:

http://www.crohnsforum.com/showthrea...=14388&page=19

Scroll down to posts number 746 and 754 and then keep reading the next few posts after this.

Good luck hun, I hope you soon have a bed and the IV potassium and magnesium soon have you feeling much better!

Dusty. xxx
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08-15-2013, 06:41 AM   #6
SarahD
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Location: Cambridge, United Kingdom
Feel better soon, the IV should help a lot x
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