Treatment of Magnesium Wasting

Acute Treatment

• For severe symptomatic hypomagnesemia, administer IV magnesium sulfate 1-2 g as a bolus push, as recommended by the American Heart Association (Class I, LOE C) 1, 3, 4
• In emergency situations such as torsades de pointes or other ventricular arrhythmias associated with hypomagnesemia, 1-2 g of IV magnesium sulfate is recommended (Class I, LOE C) 1, 3, 4
• For cardiac arrest associated with hypomagnesemia, IV magnesium 1-2 g bolus is recommended 1, 2

Maintenance Therapy

• Daily calcium and magnesium supplementation is recommended for ongoing management of magnesium wasting conditions, according to the American College of Medical Genetics and Genomics 5
• Magnesium levels should be monitored regularly, with a target of maintaining serum magnesium concentration above 1.3 mEq/L (normal range: 1.3-2.2 mEq/L) 1, 2

Special Considerations

• For patients receiving magnesium therapy, calcium (calcium chloride 10% 5-10 mL or calcium gluconate 10% 15-30 mL) should be available to reverse potential magnesium toxicity, as recommended by the American Heart Association 1, 2

Addressing Underlying Causes

• Identify and treat the underlying cause of magnesium wasting, which may include endocrine disorders (diabetes mellitus, hyperthyroidism, hyperaldosteronism) and alcoholism, according to the American College of Medical Genetics and Genomics 5