From the Guidelines
Hypomagnesemia is primarily caused by decreased absorption or increased loss of magnesium from the kidneys or intestines, with contributing factors including alterations in thyroid hormone function, certain medications, and malnourishment. The causes of hypomagnesemia can be broken down into several key categories:
- Inadequate dietary intake, which can occur due to malnutrition, alcoholism, or diets low in magnesium-rich foods like nuts, legumes, and green leafy vegetables 1
- Increased gastrointestinal losses, such as chronic diarrhea, malabsorption syndromes, inflammatory bowel disease, celiac disease, short bowel syndrome, and pancreatitis 1
- Increased renal losses, often resulting from medications like diuretics, proton pump inhibitors, certain antibiotics, calcineurin inhibitors, and platinum-based chemotherapeutics, as well as conditions such as diabetic ketoacidosis, hypercalcemia, hyperaldosteronism, and genetic disorders like Gitelman and Bartter syndromes 1
- Redistribution within the body, which can occur during refeeding syndrome, insulin administration, or acute pancreatitis 1 Other factors that can contribute to magnesium depletion include certain endocrine disorders like hyperparathyroidism, hyperthyroidism, and hyperaldosteronism, as well as severe burns, excessive sweating, and pregnancy 1. Treatment should focus on addressing the underlying cause while supplementing magnesium, typically with oral magnesium oxide, citrate, or glycinate for mild cases, or intravenous magnesium sulfate for severe deficiency or when oral supplementation isn't feasible 1.
From the Research
Causes of Hypomagnesemia
The causes of hypomagnesemia can be categorized into several groups, including:
- Inadequate magnesium intake, which can occur due to starvation, increased requirement during early childhood, pregnancy, or lactation 2
- Increased gastrointestinal losses, such as malabsorption from the gastrointestinal tract 2
- Increased renal losses, which can result from genetic or acquired renal disorders, or the use of certain drugs like loop diuretics, thiazide diuretics, and proton pump inhibitors (PPIs) 3, 4, 5, 6
- Redistribution from extracellular to intracellular space, which can occur due to various factors, including stress, injury, or surgery 2
Drug-Induced Hypomagnesemia
Several drugs have been associated with hypomagnesemia, including:
- Proton pump inhibitors (PPIs), which can increase the risk of hypomagnesemia, particularly with prolonged use 4, 5, 6
- Loop diuretics, which can inhibit sodium chloride transport in the ascending loop of Henle, leading to renal magnesium wasting and hypomagnesemia 3
- Thiazide diuretics, which can inhibit sodium chloride cotransporter in the distal convoluted tubule, leading to renal magnesium wasting and hypomagnesemia 3
Other Causes
Other causes of hypomagnesemia include:
- Genetic disorders, such as Barter syndrome and Gitelman syndrome, which can lead to renal magnesium wasting and hypomagnesemia 3
- Familial renal magnesium wasting, which can be associated with hypercalciuria, nephrocalcinosis, and nephrolithiasis 3
- Alcoholism, which can lead to inadequate magnesium intake and increased renal losses 2