Hypomagnesemia

Immediate Questions
A. What are the patient's vital signs? Cardiac
arrhythmias including atrial fibrillation,
ventricular tachycardia and ventricular
fibrillation can occur.
B. Is the patient tremulous? Tremor, tetany,
muscle fasciculations, and seizures are all
associated with magnesium deficiency.
Determining the presence of these
neurologic problems will help guide the
urgency of treatment.
 Differential Diagnosis
Hypomagnesemia can be caused
by medications, especially
diuretics, antibiotics (ticarcillin,
amphotericin B), aminoglycosides,
cisplatin, and cyclosporin, often
cause hypomagnesemia.
Alcoholism and reduced intake/
malabsorption also can cause
hypomagnesemia.
 Laboratory Data

Electrocardiograph findings may

include prolongation of the PR, QT, and
QRS intervals, as well as ST depression
and T wave changes. Rhythm
disturbances include supraventricular
arrhythmias, as well as ventricular
tachycardia and ventricular fibrillation.
 Plan
A. Asymptomatic individuals can
be treated with oral magnesium.
Oral magnesium oxide (20 meq of
magnesium per 400 mg tablet)
can be administered as 1 or 2
tablets per day; oral
administration is most appropriate
for chronic maintenance therapy.
 Plan
B. Magnesium sulfate 1 g (2 mL of a 50%
solution of MgSO4) equals 98 mg of elemental
magnesium. For moderate depletion, infuse 6
gms (12 ml of 50% MgSO4 = 6 gms) in 500 ml
saline can be given IV over 3 hours, followed
by 5 gm in 500 ml saline over the next 6
hours. The 50% solution must be diluted for IV
use. For slightly less urgent situations, 1 g/h
may be given q3-4h with close monitoring of
deep tendon reflexes. As long as signs and
symptoms of hypomagnesemia are improving,
the infusion can then be slowed
so that the patient receives approximately 10
g of magnesium sulfate in the first 24 hours.
 Plan
C. Intramuscular magnesium
sulfate. Give 1-2 g IM q4h for
5 doses during the first 24
hours.