From the FDA Drug Label
In the treatment of mild magnesium deficiency, the usual adult dose is 1 g, equivalent to 8. 12 mEq of magnesium (2 mL of the 50% solution) injected IM every six hours for four doses (equivalent to a total of 32.5 mEq of magnesium per 24 hours). For severe hypomagnesemia, as much as 250 mg (approximately 2 mEq) per kg of body weight (0. 5 mL of the 50% solution) may be given IM within a period of four hours if necessary. Alternatively, 5 g (approximately 40 mEq) can be added to one liter of 5% Dextrose Injection, USP or 0. 9% Sodium Chloride Injection, USP for slow IV infusion over a three-hour period.
The dosing for magnesium replacement is as follows:
- Mild magnesium deficiency: 1 g (8.12 mEq) IM every 6 hours for 4 doses, totaling 32.5 mEq per 24 hours.
- Severe hypomagnesemia: up to 250 mg (2 mEq) per kg of body weight IM within 4 hours, or 5 g (40 mEq) IV infusion over 3 hours. 1
From the Research
Magnesium replacement dosing should be tailored to the severity of deficiency and the clinical situation, with oral supplementation using magnesium malate or magnesium acetyl taurate being preferred due to their higher bioavailability, as shown in the study by 2. For mild to moderate hypomagnesemia, oral supplementation with magnesium malate (200-400 mg elemental magnesium daily) or magnesium acetyl taurate (200-400 mg daily) is typically recommended, divided into 2-3 doses to improve tolerance.
- The dosing may vary depending on the individual's response and serum magnesium levels.
- For severe deficiency or when oral intake isn't possible, intravenous replacement is necessary, usually with magnesium sulfate 1-2 g IV over 15-30 minutes for urgent replacement, or 4-8 g over 12-24 hours for less urgent situations, as suggested by 3 and 4.
- Patients with renal impairment require lower doses to prevent toxicity, and monitoring serum magnesium levels during replacement is crucial, aiming for levels of 1.8-2.4 mg/dL.
- Magnesium is essential for over 300 enzymatic reactions in the body, including energy production, protein synthesis, and neuromuscular function, as highlighted in 5.
- Side effects of oral magnesium include diarrhea and abdominal cramping, while IV administration may cause flushing, hypotension, and respiratory depression at high doses.
- The choice of magnesium compound is important, as some forms like magnesium oxide and magnesium citrate have lower bioavailability compared to magnesium malate and magnesium acetyl taurate, as demonstrated in 2.
- Further research is needed to investigate the bioavailability of different magnesium compounds and their effects on specific tissues and behavior, as noted in 2.