Treatment of Pediatric Hypomagnesemia

Initial Assessment and Diagnosis

Magnesium is indicated for treatment of documented hypomagnesemia in pediatric patients, with the route and dosing determined by severity of deficiency and presence of symptoms, according to the American Heart Association, as published in Circulation 1

For life-threatening arrhythmias, such as torsades de pointes, in pediatric patients with severe hypomagnesemia, the American Academy of Pediatrics recommends giving 25-50 mg/kg IV (maximum 2 g) as bolus for pulseless torsades, or over 10-20 minutes for torsades with pulses 2
Magnesium produces vasodilation and may cause hypotension if administered rapidly, as noted by the American Heart Association, highlighting the need for careful administration in pediatric patients with hypomagnesemia 1, 3

In patients with diarrhea or high gastrointestinal losses, the American Gastroenterological Association suggests correcting sodium and water depletion first to address secondary hyperaldosteronism, which increases renal magnesium wasting, before initiating magnesium supplementation 2
The National Kidney Foundation recommends avoiding magnesium supplementation if creatinine clearance <20 mL/min due to high risk of life-threatening hypermagnesemia in pediatric patients with renal impairment 2
The American Academy of Pediatrics advises monitoring for signs of magnesium toxicity, including hypotension, bradycardia, respiratory depression, and loss of deep tendon reflexes, during treatment of pediatric hypomagnesemia 2

For refractory status asthmaticus in pediatric patients, the American Thoracic Society suggests that magnesium sulfate 25-50 mg/kg IV (maximum 2 g) over 15-30 minutes may be beneficial, as part of a comprehensive treatment approach 2
Most magnesium salts are poorly absorbed and may worsen diarrhea, so the American Gastroenterological Association recommends monitoring gastrointestinal symptoms and adjusting formulation if needed in pediatric patients with hypomagnesemia 2