(for example, bone remodeling, fine-tuned insulin signaling, long‑term genomic surveillance). [12, 17, 28]
Ultimately fail in excitable tissues and hormone axes when buffering and conservation are exhausted, yielding the classic clinical syndromes of hypomagnesemia. [7, 21, 24]
A formal, quantitative hierarchy of magnesium allocation remains incomplete, and many key transporters and regulatory feedbacks are still being elucidated, but the converging evidence describes a consistent pattern: magnesium is functionally triaged to sustain core ATP-dependent viability, membrane excitability, and essential repair functions, while chronic shortfalls manifest first as subtle metabolic and structural compromise and finally as overt neuromuscular and cardiovascular instability. [1, 10, 11, 23]
Taken together, magnesium emerges as a centrally managed but locally negotiated resource that the body “spends” to keep the most vital processes running for as long as possible.
Magnesium stores in bone and muscle, dynamic control by the gut and kidney, and fine‑tuned cellular transporters all work to preserve extracellular ionized magnesium and MgATP in critical organs, especially the heart, brain, and other excitable or metabolically active tissues. Within cells, the chemistry of MgATP, the sensitivity of ion channels and DNA repair enzymes to Mg²⁺, and the adaptability of growth and stress‑response pathways create an implicit hierarchy: immediate survival functions such as membrane potential, ATP production, and essential repair are protected first, while growth, structural maintenance, and long‑term metabolic flexibility are allowed to deteriorate under chronic insufficiency.
Viewing clinical magnesium deficiency through this lens helps explain why early manifestations are subtle and systemic, why excitable tissues and hormonal networks fail so dramatically when buffering is exhausted, and why even modest, persistent deficits can drive long‑term cardiovascular, skeletal, and metabolic disease.
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