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Hypomagnesemia

Updated 2012 Feb 14 11:51:00 AM: hypomagnesemia associated with higher mortality and increased risk of needing
ventilators in critically ill patients (J Assoc Physicians India 2011 Jan) view update Show more updates

Related Summaries:
Hypokalemia
Hypocalcemia

General Information

Description:
magnesium < 1.8 mg/dL (0.74 mmol/L)(2)

Types:
magnesium deficiency from inadequate intake
magnesium depletion from metabolic loss

Who is most affected:

most often seen with patients(1)
in intensive care
with malabsorptive disorders
with renal disease
older adults are at increased risk(1)

Incidence/Prevalence:
estimated prevalence in general population 2.5%-15%(1)
65% incidence in intensive care patients(1)
hypomagnesemia in 60% of critically ill children admitted to pediatric ICU in India with incidence rate 30.1 per 100 patients days
(J Trop Pediatr 2003 Apr;49(2):99 EBSCOhost Full Text)
Causes and Risk Factors

Causes:
hypomagnesemia may be caused by inadequate intake of magnesium with conditions such as(1, 2, 3)
malnutrition (including protein-calorie malnutrition)
alcoholism
anorexia nervosa
terminal cancer
total parenteral nutrition
increased gastrointestinal loss of magnesium may be caused by (1, 2)
acute or chronic diarrhea
malabsorption and steatorrhea
small bowel bypass surgery
vomiting and nasogastric suction
gastrointestinal fistulas
hypomagnesemia with secondary hypocalcemia (HSH)
laxative abuse
proton pump inhibitors
hypomagnesemia may be caused by redistribution of magnesium from extracellular to intracellular space(1, 2)
treatment of diabetic ketoacidosis
refeeding syndrome
hungry bone syndrome
correction of metabolic acidosis
acute pancreatitis

(1, 2)
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renal disease may cause excessive loss of magnesium (1, 2)

inherited renal tubular defects associated with excessive magnesium loss include(1, 2)
Gitelman syndrome
classic Bartter syndrome (Type III)
familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC)
autosomal-dominant hypocalcemia with hypercalciuria (ADHH)
isolated dominant hypomagnesemia (IDH) with hypocalciuria
isolated recessive hypomagnesemia (IRH) with normocalcemia
hypomagnesemia with secondary hypocalcemia (HSH)
other conditions associated with hypomagnesemia(1)
extracellular fluid volume expansion
recovery phase of acute tubular necrosis
severe cutaneous loss of magnesium as in burns (Rev Endocr Metab Disord 2003 May;4(2):195)
drugs that may be associated with increased risk of hypomagnesemia(1, 2)
diuretics – loop and thiazide
antimicrobials (amphotericin B, aminoglycosides, foscarnet)
chemotherapeutic agents – cisplatin
immunosuppressants (tacrolimus, cyclosporine)
degree of effect by specific drug type
significant - occurs in many cases with severe/moderate manifestations
amphotericin B
cisplatin
ciclosporin
potentially significant - few cases with severe/moderate manifestations or many cases with mild manifestations
amikacin
foscarnet
gentamicin
laxatives
pentamidine
phosphates
theophylline
tobramycin
tacrolimus
carboplatin
questionable significance few cases with mild manifestations
arsenic trioxide
capreomycin
pamidronate
aldesleukin
amsacrine
bendroflumethiazide
capreomycin
furosemide
hydrochlorothiazide
methyclothiazide
zolendronate
Reference - Drug Saf 2005;28(9):763 EBSCOhost Full Text
proton pump inhibitors
FDA warns of possible increased risk of hypomagnesemia with long-term proton pump inhibitor (PPI) use
FDA recommends evaluating serum magnesium levels prior to initiating long-term PPI therapy, or in patients
concurrently taking digoxin, diuretics or other drugs associated with hypomagnesemia
Reference - FDA MedWatch 2011 Mar 2
pyridylmethylsulphonyl benzimidazadole derivative proton pump inhibitors associated with
hypomagnesemia (level 2 [mid-level] evidence)
based on systematic review of case reports
systematic review of 28 case studies of patients on proton pump inhibitor (PPI) therapy with recurrent
hypomagnesemia

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PPIs were all pyridylmethylsulphonyl benzimidazadole derivatives including rabeprazole, esomeprazole, omeprazole,
lansoprazole and pantoprazole
61% had PPI treatment ≥ 5 years
29% had PPI treatment ≥ 10 years
plasma magnesium returned to normal after withdrawal of PPI in all patients
Reference - Curr Opin Gastroenterol 2011 Mar;27(2):180
severe hypomagnesemia reported in 3 patients with ESHAP protocol using etoposide, methylprednisolone, cytarabine and
cisplatin (BMC Blood Disord 2002;2(1):1 full-text)
review of hypomagnesemia due to targeted anti-epidermal growth factor receptor (EGFR) agents can be found in (Target Oncol
2011 Dec;6(4):227 EBSCOhost Full Text)

Pathogenesis:
1% of total body magnesium exists in serum (70% is ionized, active form and 30% inactive, bound to albumin)(1, 2)
serum magnesium may be normal in presence of total body magnesium depletion
total magnesium measurement may overestimate hypomagnesemia in presence of hypoalbuminemia
approximately 99% of total body magnesium is intracellular (85% stored in the bone)(1)
serum magnesium concentration balanced between intestinal absorption and renal excretion(1)
intracellular magnesium deficiency impairs sodium/potassium adenosine triphosphates membrane pump which decreases
intracellular potassium (hypokalemia) leading to(1)
disturbance of resting membrane potential and repolarization phase of myocardial cells
ECG changes (may include flattened T-waves, U-waves, prolonged QT interval and widened QRS complexes)
increased potential of atrial and ventricular arrhythmias
hypomagnesemia may cause hypocalcemia through suppression of parathyroid hormone (PTH) release and inducing end-organ
resistance to PTH(1)

Likely risk factors:

alcoholism associated with magnesium poor diet and increase in urinary magnesium wasting with alcohol intoxication and
predisposition to diarrhea and acute/chronic pancreatitis(3)
chronic use of
diuretics
laxatives
proton pump inhibitors
some immunosuppressant
antimicrobials
antifungals
Reference - Drug Saf 2005;28(9):763 EBSCOhost Full Text
sepsis and diabetes associated with increased risk of hypomagnesemia in critically ill patients
based on prospective cohort study
100 patients admitted to acute care unit with recorded serum magnesium levels
52% had hypomagnesemia, 41% had normal magnesium, 7% had hypermagnesemia on admission
compared to patients with normal magnesium, patients with hypomagnesemia more likely to have
sepsis (p < 0.05)
hypocalcemia (p < 0.05)
hypoalbuminemia (p < 0.05)
patients with diabetes mellitus were more likely to have hypomagnesemia (70%) than patients without diabetes (47%) (p
< 0.05)
Reference - J Assoc Physicians India 2011 Jan;59:19
sepsis and aminoglycoside use associated with increased risk of hypomagnesemia in critically ill children
based on retrospective cohort study
179 children aged 1 month to 15 years admitted to intensive care unit over 18 months with record of serum magnesium
44% had hypomagnesemia
factors associated with hypomagnesemia
age > 1 year (odds ratio [OR] 3.71, 95% CI 1.56-8.69)
sepsis (OR 3.11, 95% CI 1.1-8.58)
aminoglycoside use (OR 3.12, 95% CI 1.1-8.9)
Reference - Indian J Pediatr 2009 Dec;76(12):1227 EBSCOhost Full Text
history of alcoholism, diabetes, and renal disease associated with increased risk of asymptomatic
hypomagnesemia

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based on retrospective cohort study
120 patients (predominantly female and African American) at urban medical center with blood work for routine medical care
with magnesium testing
20% had hypomagnesemia
increased risk of hypomagnesemia in patients with
history of alcoholism (odds ratio [OR] 6, 95% CI 1.41-26.1)
≥ 1 of the following: diabetes, hyperlipidemia, hypertension, renal disease, and asthma (OR 4.69, 95% CI 1.37-17.65)
Reference - (J Fam Pract 1999 Aug;48(8):636)

Factors not associated with increased risk:

poor diet alone not likely to cause hypomagnesemia but may exacerbate it when occurs in conjunction with other symptoms like
diarrhea(3)
Complications and Associated Conditions

Complications:
hypomagnesemia associated with(1, 2, 3)
hypokalemia in 40%-60% of patients with hypomagnesemia
hypocalcemia - classical sign of severe hypomagnesemia
aggravation of digitalis toxicity
ventricular or atrial arrhythmias
increased platelet aggregation in people with diabetes
intermittent downbeat nystagmus, cerebellar ataxia, generalized convulsions and a supraventricular tachycardia with severe
hypomagnesemia in case report (Biol Trace Elem Res 2011 Aug;142(2):127 EBSCOhost Full Text)
hypomagnesemia induced seizures in patient aged 73 years after ileal resection and limited right hemicolectomy for small bowel
volvulus in case report (BMJ Case Rep 2009;2009: full-text)
abortion or preterm labor can occur with magnesium deficiency (2)

Associated conditions:
hypomagnesium may complicate or be a result of other medical conditions such as(1, 2)
mitral valve prolapse (MVP)
vitamin D deficiency
cardiopulmonary bypass
diabetes - related to metabolic control, frequency and severity of hyperglycemia)
cardiovascular diseases such as heart failure, acute myocardial infarction with sudden death and recurrent and therapy
unresponsive arrhythmias
hypomagnesemia reported in patients with cystic fibrosis preparing for lung transplant
based on retrospective cohort study
106 patients with cystic fibrosis assessed for lung transplant
57% of patients had hypomagnesemia
Reference - J Cyst Fibros 2007 Sep;6(5):360
review of magnesium and mitral valve prolapse can be found in Magnes Res 2005 Mar;18(1):35 full-text full text
retinitis pigmentosa in women with chronic hypomagnesemia in case report (Clin Experiment Ophthalmol 2010 Aug;38(6):645
EBSCOhost Full Text)
History and Physical

History:

Chief concern (CC):

most patients are asymptomatic until concentration is < 1.2 mg/dL (0.5 mmol/L)(1)
severe hypomagnesemia < 0.4 MM may cause seizures, drowsiness, confusion and coma(1)
symptoms associated with hypomagnesemia occurring in conjunction with hypokalemia or hypocalcemia include(1, 3)
muscular weakness or twitching
fatigue
tremors
paraesthesia
tetany and seizures in severe cases
apathy or depression

Medication history:

(1)
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ask about use of(1)
diuretics
antimicrobial medications
chemotherapeutic agents
immunosuppressants
proton pump inhibitors
laxatives
also see causes

Past medical history (PMH):

ask about(1)
kidney disease
alcoholism
anorexia nervosa
recent/current parenteral nutrition
diabetes
recent/current diarrhea and or vomiting
surgical procedures of intestines
parathyroid disease or removal
refractory hypokalemia or hypocalcemia(3)

Physical:

HEENT:
vertical nystagmus(1)

Cardiac:
arrhythmias (ventricular or atrial)(1)
ECG changes with hypomagnesemia may include flattened T-waves, U-waves, prolonged QT interval and widened QRS
complexes(1)
hypotension (Am Fam Physician 1990 Jul;42(1):173)

Lungs:
respiratory muscle weakness (Am Fam Physician 1990 Jul;42(1):173)

Neuro:
positive Chvostek's and Trousseau's signs(2)
muscular weakness or twitching(2)
tremors(2)
paraesthesia(2)
tetany and seizures in severe cases(2)
Diagnosis

Making the diagnosis:

plasma level of magnesium in blood to confirm hypomagnesemia(2)
normal range 1.8 mg/dL (0.74 mmol/L) to 2.3 mg/dL (0.94 mmol/L)
hypomagnesemia < 1.8 mg/dL (0.74 mmol/L)
normomagnesemia may exist with cellular magnesium depletion
if normomagnesemic but magnesium depletion is still suspected from symptoms such as refractory hypokalemia or unexplained
hypocalcemia, consider magnesium infusion test(1)

Differential diagnosis:
determine extra-renal or renal causes(3)
underlying cause (see Causes)

Testing overview:
blood serum levels of magnesium, calcium and potassium(1, 2, 3)
testing to determine source of hypomagnesemia may include(1)
24 hour urinary magnesium excretion for renal magnesium avidity, in presence of hypomagnesium
fractional excretion of magnesium (FEMg) to distinguish between gastrointestinal and renal magnesium loss, in presence of
hypomagnesium(1)
if normomagnesemic but magnesium depletion is still suspected consider magnesium infusion test(1)
(1)
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electrocardiogram (ECG) for signs of hypomagnesemia in heart(1)

Blood tests:
consideration with serum levels of magnesium(2)
normal concentration of magnesium does not rule out primary chronic magnesium deficit, suspect intracellular magnesium
deficit with strong clinical suggestion
total magnesium measurement may overestimate incidence of hypomagnesemia in presence of hypoalbuminemia
measurement of ionized magnesium may be best in patients with hypoalbuminemia and expected hypomagnesemia or with
ethanol ingestion

Urine studies:
24 hour urinary magnesium excretion for renal magnesium avidity, in presence of hypomagnesemia(1)
excretion < 12 mg (0.5 mmol) consistent with intact renal response
levels > 24 mg (1 mmol) indicates abnormal renal wasting
fractional excretion of magnesium (FEMg) to distinguish between gastrointestinal and renal magnesium loss, in presence of
hypomagnesemia(1)
FEMg > 2% suggest inappropriate renal wasting
FEMg < 2% suggests extra-renal magnesium losses, decreased intake or absorption
for patient with strong clinical signs suggesting hypomagnesemia despite normal serum levels consider magnesium infusion
test(1)
measure retention after magnesium loading
surrogate measure for intracellular magnesium
reduced excretion (< 80% over 24 hours) of an infused magnesium load (2.4 mg/kg of lean body weight over initial 4
hours) suggest magnesium deficiency)
false-positive results typically seen in patients with malnutrition, cirrhosis, diarrhea or long-term diuretic use

Electrocardiography (ECG):
hypomagnesemia may cause(1)
flattened T-waves, U-waves, prolonged QT interval and widened QRS complexes
atrial and ventricular arrhythmias
Treatment

Treatment overview:
oral magnesium supplementation may be used for asymptomatic patients with mild to moderate hypomagnesemia
tablets contain magnesium 5-7 mEq (2.5-3.5 mmol or 60-84 mg) per tablet
2-4 tablets/day for mild depletion, 6-8 tablets/day for severe depletion
magnesium citrate more bioavailable than other forms of magnesium (level 3 [lacking direct] evidence)
IV magnesium sulfate used for symptomatic hypomagnesemia
8-12 g in first 24 hours, then 4-6 g/day for 3-4 days
maximum infusion rate 2 g/hour
target serum magnesium level > 1 mg/dL (0.4 mmol/L or 0.8 mEq/L)
if renal insufficiency, reduce initial doses by 50%-75%
intramuscular administration (magnesium sulfate 1-2 g in 2-4 mL every 6-24 hours for 4 doses) can be used if no IV
access, but intramuscular dose is painful
underlying cause of hypomagnesemia needs to be addressed to avoid refractory episode
other electrolyte disturbances (hypokalemia, hypocalcemia) cannot be resolved until magnesium is balanced

Medications:

Oral magnesium:
oral magnesium supplements for asymptomatic patients with mild to moderate deficiency (1.2 mg/dL-1.7 mg/dL)(1, 2)
6-8 tablets daily in divided doses for severe depletion with 5-7 mEq (2.5-3.5 mmol or 60-84 mg) of magnesium per tablet
2-4 tablets daily for mild asymptomatic disease
high doses > 10 mg/kg/day for chronic hypomagnesemia
magnesium salts can be used but generally not well-absorbed from gastrointestinal tract
consider magnesium sulphate - osmotic sulphate to avoid absorption problem
oral magnesium oxide as successful treatment of hypomagnesemia due to malabsorption in patient not responsive to oral
magnesium glycerophosphate in case report (Gut 2001 Jun;48(6):857 EBSCOhost Full Text full-text)
magnesium citrate more bioavailable than other forms of magnesium (level 3 [lacking direct] evidence)
based on randomized trial without clinical outcomes

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46 healthy individuals randomized to elemental magnesium 300 mg/day for 60 days using magnesium citrate vs.
magnesium amino-acid chelate vs. magnesium oxide vs. placebo
magnesium citrate associated with highest increases in serum and salivary magnesium levels
magnesium citrate and amino-acid chelate associated with higher urinary magnesium excretion than magnesium oxide
Reference - Magnes Res 2003 Sep;16(3):183 full-text in Altern Ther Health Med 2004 Sep-Oct;10(5):87
magnesium supplementation associated with reduced number of symptoms and decreased catecholamine
excretion in patients with mitral valve prolapse (MVP) and hypomagnesemia (level 2 [mid-level] evidence)
based on randomized trial
84 patients with MVP and symptomatic hypomagnesemia randomized to magnesium supplementation vs. placebo than
crossed over to alternate treatment
patients reported variety of symptoms such as chest pain, palpitations, anxiety, hyperemotionalism, dyspnea, headache,
weakness, numbness, fainting, dizziness, low vital energy, musculoskeletal pains, cramps
magnesium supplementation at 5 weeks associated with significant decrease in
number of symptoms compared to placebo (particular decrease in weakness, chest pain, dyspnea, palpitations, and
anxiety)
mean daily excretion of noradrenaline and adrenaline
Reference - Am J Cardiol 1997 Mar 15;79(6):768, commentary can be found in Am J Cardiol 1997 Oct 1;80(7):976

Injectable magnesium:
IV magnesium sulfate for symptomatic patients(1, 2, 3)
administration 8-12 g of magnesium sulphate in first 24 hours followed by 4-6 g/day for 3-4 days to replete body stores
aiming for serum magnesium concentrations > 1 mg/dL (0.4 mmol/L or 0.8 mEq/L)
for patients with tetany or with ventricular arrhythmias - 50 mEq given slowly over 8-24 hours, repeated as necessary to
maintain plasma magnesium > 1 mg/dL (0.4 mmol/L or 0.8 mEq/L), repeat dose daily for 3-5 days
maximum infusion rates should not exceed 2 g/hour, rapid IV push raises serum magnesium above physiological levels and
causes large percentage of magnesium to be excreted in urine
patients with renal insufficiency should receive 25%-50% of recommended initial dose
monitor pulse, arterial pressure, deep tendon reflexes, hourly diuresis, ECG and respiratory recording in critically ill patients
intramuscular dose is painful and should be reserved for patients with no IV access(1)
undiluted 50% solution - therapeutic serum levels in 60 minutes 1-2 g of magnesium sulphate (2-4 mL of 50% solution)
injected intramuscularly every 6-24 hours (4 doses in total)
self-administered subcutaneous magnesium in patient with recurrent severe hypocalcemia, secondary to hypomagnesemia in
case report (Nutr Hosp 2009 May-Jun;24(3):354 EBSCOhost Full Text full-text)
IV magnesium associated with improved magnesium serum concentrations in patients in intensive care unit
(level 3 [lacking direct] evidence)
based on small randomized trial without clinical outcomes
32 patients in intensive care unit with hypomagnesemia within 24 hours of trial randomized to magnesium sulfate 2 g (8
mmol) IV infusion over 30 minutes every 6 hours for 8 doses vs. placebo
routine replacement of magnesium with serum concentrations < 1.8 mg/dL (< 0.74 mmol/L) in all patients
magnesium associated with
significant increase in serum magnesium concentration at 6 hours compared to placebo and baseline levels (p <
0.0001)
significantly greater urine magnesium excretion than placebo (p < 0.0001)
net potassium balance at 48 hours was positive with magnesium vs. negative with placebo (p < 0.05)
Reference - Crit Care Med 1996 Jan;24(1):38
Prognosis
hypomagnesemia on admission to critical care associated with increase morbidity and mortality in adults
hypomagnesemia associated with higher mortality and increased risk of needing ventilators in critically ill
patients (level 2 [mid-level] evidence)
based on prospective cohort study
100 patients admitted to acute care unit with recorded serum magnesium levels
52% had hypomagnesemia, 41% had normal magnesium, 7% had hypermagnesemia on admission
comparing hypomagnesemia vs. normal magnesium
mortality 57.7% vs. 31.7% (p < 0.05)
need for ventilator 73% vs. 53% (p < 0.05)
longer duration of ventilation 4 days vs. 2 days (p < 0.05)
no significant difference in Acute Physiology And Chronic Health Evaluation (APACHE) score

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Reference - J Assoc Physicians India 2011 Jan;59:19
hypomagnesemia at admission or during stay associated with increased morbidity and mortality in adults
admitted to critical care unit (level 2 [mid-level] evidence)
based on retrospective cohort study
100 patients age ≥ 16 years admitted to intensive care unit (ICU) over 2 year period with magnesium screenings
completed as part of care
51% had hypomagnesemia at admission
comparing patients with hypomagnesemia vs. normal magnesemia
mortality rate 55% vs 35% (p < 0.05)
length of hospital 15 days vs. 12 days (p < 0.05)
ICU stay 9 days vs. 5 days (p < 0.05)
compared to patients with normal magnesemia, patients who developed hypomagnesemia during ICU stay were more
likely to have
higher Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment
(SOFA) scores at admission (p < 0.01 for both)
higher maximum SOFA score during their ICU stay (p < 0.01)
increased need for ventilator (p < 0.05)
longer duration of mechanical ventilation (p < 0.01)
Reference - Middle East J Anesthesiol 2007 Oct;19(3):645
hypomagnesemia associated with increased risk of continued renal failure and in-hospital mortality in
patients with AIDS and acute kidney injury (level 2 [mid-level] evidence)
based on prospective cohort study
54 patients hospitalized with HIV infection and acute renal injury had serum magnesium assessed
principal causes of renal failure sepsis, dehydration, and treatment with nephrotoxic drugs
56% survived and 33% recovered renal function
hypomagnesemia associated with increased risk of
nonrecovery of renal function (odds ratio [OR] 6.94, 95% CI 1.2-39.9)
in-hospital mortality (OR 6.92, 95% CI 1.17-40.8)
Reference - Braz J Med Biol Res 2010 Mar;43(3):316 full-text
hypomagnesemia at admission to intensive care unit associated with increased risk of mortality in patients
with type 2 diabetes(level 2 [mid-level] evidence)
based on prospective cohort study
14 adults with type 2 diabetes admitted to intensive care unit (ICU) had serum magnesium assessed and followed for
length of ICU stay
72% had hypomagnesemia defined as serum magnesium levels < 0.66 mmol/L (1.6 mg/dL) at admission
mortality in 80% with hypomagnesemia vs. 25% with normal magnesium
serum magnesium levels significantly lower in patient who died compared to patients who survived (p = 0.01)
Reference - Magnes Res 2008 Sep;21(3):163 PDF
mixed evidence of hypomagnesemia impact on mortality in children in intensive care
hypomagnesemia not associated with increased mortality or longer hospitalization in critically ill children
(level 2 [mid-level] evidence)
based on retrospective cohort study
179 children aged 1 month to 15 years admitted to intensive care unit over 18 months with record of serum
magnesium
44% had hypomagnesemia
no significant difference in length of hospitalization or mortality
Reference - Indian J Pediatr 2009 Dec;76(12):1227 EBSCOhost Full Text
hypomagnesemia with or without hypocalcemia associated with increased mortality in critically ill children
(level 2 [mid-level] evidence)
based on prospective cohort study
100 children aged 6 months to 12 years admitted to pediatric intensive care unit with record of serum magnesium
60% had hypomagnesemia, most common with raised intracranial pressure
mortality in
30% with hypomagnesemia vs. 3% with normal serum magnesium
33% with both hypomagnesemia and hypocalcemia vs. no deaths with normal serum magnesium and calcium (p
< 0.05)
Reference - J Trop Pediatr 2003 Apr;49(2):99 EBSCOhost Full Text

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Prevention and Screening

Prevention:
patients with chronic renal magnesium wasting or diuretic-induced hypomagnesemia who cannot discontinue diuretic may benefit
from addition of potassium-sparing diuretics like amiloride or triamterene(1)
suggested steps for prevention with drugs at risk for hypomagnesemia
significant degree of risk
routine magnesium monitoring
preventive treatment (supplementation) with or without overt clinical manifestations
potentially significant degree of risk
magnesium monitoring when clinical manifestations are apparent such as persistent hypokalemia or hypocalcemia,
presence of other precipitating factors or additional drugs with risk
no preventive treatment is warranted
treatment only with symptoms or clinically relevant findings
questionable degree of risk - monitoring and treatment not required
Reference - Drug Saf 2005;28(9):763 EBSCOhost Full Text
magnesium sulfate supplementation 50 mg/kg may reduce incidence of hypomagnesemia in children having
cardiac surgery (level 2 [mid-level] evidence)
based on small randomized trial
99 children having cardiac surgery randomized to magnesium sulfate 25 mg/kg vs. magnesium sulfate 50 mg/kg vs.
placebo during rewarming phase of cardiopulmonary bypass
incidence of hypomagnesemia
47.4% in magnesium 50 mg/kg group (p < 0.05 vs. placebo)
63% in magnesium 25 mg/kg group (not significant vs. placebo)
77.8% in placebo group
magnesium supplement associated with significantly reduced incidence of junctional ectopic tachycardia
Reference - J Thorac Cardiovasc Surg 2010 Jan;139(1):162

Screening:
no evidence examining screening for hypomagnesemia with MEDLINE search January 6, 2011
Guidelines and Resources
Patient Information
ICD-9/ICD-10 Codes
References

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