Hypomagnesemia treatment - Magnesium deficiency treatment

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What is the treatment for hypomagnesemia?

The treatment of hypomagnesemia (serum magnesium deficiency) is by magnesium (Mg²⁺) repletion.

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Depending upon the severity of hypomagnesemia symptoms as well as the level of serum magnesium depletion, oral or intravenous routes are selected. Very mild asymptomatic hypomagnesemia can be corrected and treated by eating
foods rich in magnesium, such as dark green leafy vegetables, whole grains, legumes and nuts.

Hypomagnesemia is an underrecognized, underdiagnosed and inappropriately treated condition which may lead to serious consequences. Though magnesium is abundantly available from plant sources around us, a paradoxical situation is that a big chunk of the population is found to be deficient in the mineral in USA. Please note that the green color of plants is due to the presence of chlorophyll, an essential molecule for photosynthesis. Mg²⁺ is an essential component of chlorophyll molecule.

Treatment for mild hypomagnesemia

Being an electrolyte disorder, the removal of the underlying cause is the first step of treatment of hypomagnesemia. Asymptomatic patients should be treated with oral supplements. For mild to moderate magnesium depletion (1.2 mg/dL to 1.7 mg/dL), the first line of treatment is with oral tablets or suspension containing the mineral. Considering ability of the mineral to induce diarrhea, a sustained-release preparation may be prefered in hypomagnesemia treatment. If the gastrointestinal tract functioning is normal, the bioavailability of the oral supplement may be assumed to be one third of the dose.

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Magnesium oxide 400 mg (240 mg of element) tablet may be taken twice or thrice a day.
Milk of magnesia suspension 5 ml (240 mg of element) may be given twice or thrice a day.
Magnesium gluconate 500 mg (112 mg of element) one to two tablets may be given up to four times a day.

Treatment for severe hypomagnesemia

Symptomatic patients with severe magnesium depletion (less than 1.2 mg/dL) and patients who cannot tolerate oral supplements are administered with parenteral supplements. Sustained repletion of Mg²⁺ is required in severe hypomagnesemia. The serum concentration of the mineral is the major regulator of its reabsorption by active magnesium transport.

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As the process of Mg²⁺ reaching homeostasis and equilibrium between serum and the intracellular spaces and tissues takes some time, the measurement of the serum levels soon after infusion may appear high.

Hypomagnesemia and impaired magnesium homeostasis

Hypomagnesemia with impaired homeostasis does not resolve unless magnesium depletion as well as the associated K, Na and Ca depletions are treated. Any abrupt rise in concentration due to speedy parenteral administration can decrease the stimulus for reabsorption, leading to nearly 50% loss of the infused mineral in urinary excretion. Hypomagnesemia patients with impaired renal function must be monitored closely as they are very sensitive to intravenous magnesium replacement and there is always the possibility of developing acute hypermagnesemia.

Hypomagnesemia, hypokalemia and hypocalcemia

Magnesium is infused normally in its sulfate form. Sulfate ions may bind to calcium ions and increase urinary loss of calcium. In the event of concomitant hypocalcemia, ionized calcium levels can drop acutely leading to tetany during magnesium sulfate infusion.

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Hence hypocalcemia also must be treated simultaneously with hypomagnesemia. The negative transepithelial potential difference created by the sulfate ions in the renal tubules increases potassium loss. In case of the patient having concomitant hypokalemia, the potassium loss may worsen.

Gestational and diuretic-induced hypomagnesemia

Thiazide-type diuretic medications deplete K⁺ and Mg²⁺. Potassium-sparing diuretics can increase Mg²⁺ reabsorption in the cortical collecting duct and benefit the hypomagnesemia patient. Mg²⁺ depletion occurs in pregnant women leading to hypertension and preeclampsia. Timely Mg²⁺ spplementation can eliminate maternal, fetal, and pediatric consequences of depletion. Type 2 diabetes patients quite often develop hypomagnesemia. Diabetes control measures and magnesium supplementation can bring relief.

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References:
1.Kevin J. Martin, Esther A. González, Eduardo Slatopolsky. Clinical Consequences and Management of Hypomagnesemia. JASN November 1, 2009 vol. 20 no. 11 2291-2295.
2.Durlach J. New data on the importance of gestational Magnesium deficiency. J Am Coll Nutr. 2004 Dec;23(6):694S-700S.
3.Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr. 2009 Apr;28(2):131-41.
4.Fakih MG, Wilding G, Lombardo J. Cetuximab-induced hypomagnesemia in patients with colorectal cancer. Clin Colorectal Cancer. 2006 Jul;6(2):152-6.

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