Antacids that contain magnesium have a laxative effect that may cause diarrhea,

The other problem with using antacids for an upset stomach is that they dont work. What?!
you say. I can tell the difference after I take it! Actually, unless you have an ulcer, this is
probably a placebo effect. Antacids were clinically proven ineffective by a Swedish study in
1986. In fact, antacids will sometimes cause your stomach to produce more acida condition
called acid rebound, which worsens your GI problem. Also, antacids change the pH environment
of the gut, potentially causing an imbalance of friendly flora and putting you at risk for infection
by the unfriendly types. Some believe that antacids may even help set the stage for infection with
Helicobacter pylori, the bacterium that causes ulcers. - See more at:
http://drhoffman.com/article/antacids-not-the-anti-you-think-they-are-2/#sthash.fhh6s7pG.dpuf
magnesium stimulates muscle contractions; however, the simultaneous activation
of the intrinsic nerves, which are predominantly inhibitory, by magnesium may
conceal the muscular effects of this cation. Al by itself produces constipation due to
an astringent action, and Mg(OH)2 produces diarrhea by an osmotic mechanism
The diarrhea caused by magnesium hydroxide carries away much of the body's
supply of potassium, and failure to take extra potassium may lead to muscle cramps
However, high doses of magnesium from dietary supplements or medications often
result in diarrhea that can be accompanied by nausea and abdominal cramping [1].
Forms of magnesium most commonly reported to cause diarrhea include
magnesium carbonate, chloride, gluconate, and oxide [11]. The diarrhea and
laxative effects of magnesium salts are due to the osmotic activity of unabsorbed
salts in the intestine and colon and the stimulation of gastric motility [55].
Obat dengan kandungan aluminium atau magnesium bekerja secara kimiawi
mengikat kelebihan HCl dalam lambung. Sediaan yang mengandung magnesium
menyebabkan diare karena bersifat pencahar, sedangkan sedangkan sediaan yang
mengandung aluminium dapat menyebabkan sembelit maka biasanya kedua
senyawa ini dikombinasikan. Persenyawaan molekul antara Mg dan Al disebut
hidrotalsit.
Magnesium hidroksida digunakan sebagai katartik dan antasida, tidak larut dan
efektif sebelum obat ini bereaksi dengan HCl membentuk MgCl 2. Magnesium
hidroksida yang tidak larut akan tetap berada dalam lambung dan akan
menetralkan HCl yang disekresi belakangan sehingga masa kerjanya lama. Satu
gram magnesium hidroksida dapat menetralisir 32,6 mEq dari asam lambung.
Senyawa magnesium memiliki kelebihan berupa absorpsi yang kecil, aksi yang
tahan lama dan tidak menghasilkan karbondioksida
Magnesium Hidroksida Menetralkan asam lambung Diare, sebanyak 5-10 %
magnesium diabsoprsi dan dapat menimbulkan kelainan neurologi, neuromuskular,
dan kardiovaskular.

Beberapa merk maag yang di dalamnya terkandung antasida ( alumunium hidroksida dan
magnesium hidroksida antara lain : mylanta, promaag, magasida, antasida doen dan msgalat,
beberapa berbentuk tablet dan syrup. Antasida mengandung senyawa magnesium hidroksida dan
aluminium hidroksida yang diberikan secara oral (diminum) dan berfungsi untuk menetralkan
asam lambung. Antasida bekerja dengan cara menetralkan lambung yang terlalu asam. Selain
menetralkan asam lambung, antasida juga meningkatkan pertahanan mukosa lambung dengan
memicu produksi prostaglandin pada mukosa lambung.
Antasida yang terdiri dari kombinasi alumunium hidroksida dan magnesium hidroksida dipilih
karena menghasilkan efek non sistemik dengan masa kerja panjang. Alumunium hidroksida
dapat menyebabkan konstipasi dan magnesium hidroksida menyebabkan diare, dengan
memadukan keduanya akan dapat meminimalisir efek samping yang ditimbulkan.
Sebelum dikeluarkan dari tubuh, obat mengalami proses metabolisme (biotransformasi) terlebih
dahulu. Biotransformasi atau metabolisme obat adalah proses perubahan struktur kimia obat
yang terjadi di dalam tubuh dan dikatalis oleh enzim. Pada proses ini molekul obat di ubah
menjadi lebih polar artinya lebih mudah larut dalam air dan kurang larut dalam lemak sehingga
lebih mudah diekskresi melalui ginjal. Selain itu, pada umumnya obat menjadi inaktif, sehingga
biotransformasi sangat berperan dalam mengakhiri kerja obat.
Absorption of water in the intestines is dependent on adequate absorption of solutes. If excessive
amounts of solutes are retained in the intestinal lumen, water will not be absorbed and diarrhea
will result. Osmotic diarrhea typically results from one of two situations:

Ingestion of a poorly absorbed substrate: The offending molecule is usually a

carbohydrate or divalent ion. Common examples include mannitol or sorbitol, epson salt
(MgSO4) and some antacids (MgOH2).

Malabsorption: Inability to absorb certain carbohydrates is the most common deficit in

this category of diarrhea, but it can result virtually any type of malabsorption. A common
example of malabsorption, afflicting many adults humans and pets is lactose intolerance
resulting from a deficiency in the brush border enzyme lactase. In such cases, a moderate
quantity of lactose is consumed (usually as milk), but the intestinal epithelium is deficient
in lactase, and lactose cannot be effectively hydrolyzed into glucose and galactose for
absorption. The osmotically-active lactose is retained in the intestinal lumen, where it
"holds" water. To add insult to injury, the unabsorbed lactose passes into the large
intestine where it is fermented by colonic bacteria, resulting in production of excessive
gas.

The small bowel mucosa is a porous epithelium; water and salts move across it
rapidly to maintain osmotic balance between the bowel contents and the blood.
Under these conditions, diarrhoea can occur when a poorly absorbed, osmotically
active substance is ingested. If the substance is taken as an isotonic solution, the

water and solute will simply pass through the gut unabsorbed, causing diarrhoea.
Purgatives, such as magnesium sulfate, work by this principle. The same process
may occur when the solute is lactose (in children with lactase deficiency) or glucose
(in children with glucose malabsorption); both conditions are occasional
complications of enteric infections. If the poorly absorbed substance is taken as a
hypertonic solution, water (and some electrolytes) will move from the ECF into the
gut lumen, until the osmolality of the intestinal contents equals that of ECF and
blood. This increases the volume of the stool and, more importantly, causes
dehydration owing to the loss of body water. Because the loss of body water is
greater than the loss of sodium chloride, hypernatraemia also develops (see below).

To understand better what causes diarrhea and how to treat it, one must first have an
understanding of the normal digestive system. Approximately 2 liters are ingested daily in the
normal diet. By the time this food material has reached the proximal duodenum, another 7 liters
of digestive secretions from the stomach, liver, pancreas, intestine, and salivary glands have been
added. As this chyme is passed along the small intestine, the osmolality is adjusted so that, at the
distal ileum, the bowel contents are isotonic with plasma and total only 1 to 2 liters.
The colon absorbs much of the remaining fluid, leaving approximately 100 to 150 cc of slightly
hypertonic stool to be excreted. The colon has the capacity to absorb up to about 4 liters per day,
but normally one's excretory patterns prevent complete desiccation of the bowel movement.
Diarrhea results when there is alteration of this normal physiologic process of digestion and
absorption. There are multiple causes for diarrhea and there may be multiple pathophysiologic
mechanisms for a single disease entity. Nonetheless, the following pathophysiologic
classification provides a useful framework for approaching diarrhea:

Diarrhea secondary to altered mucosal transport or secretory dysfunction

Osmotic diarrhea

Diarrhea secondary to malabsorption

Exudative diarrhea

Diarrhea secondary to altered bowel motility

Osmotic diarrhea results from the presence of osmotically active, poorly absorbed
solutes in the bowel lumen that inhibit normal water and electrolyte absorption.
Certain laxatives such as lactulose and citrate of magnesia or maldigestion of
certain food substances such as milk are common causes of osmotic diarrhea. An
increased osmotic load can be measured in the stool. This type of diarrhea ceases
with fasting.

Demam, lemas, diare,