From the Guidelines
The recommended oral treatment for hypomagnesemia is organic magnesium salts, such as magnesium citrate or magnesium aspartate, due to their higher bioavailability compared to magnesium oxide. For mild to moderate deficiency, a dose of 300-600 mg daily in divided doses is typically effective 1. Treatment duration depends on the severity of deficiency and underlying cause, but usually continues for 1-2 months while monitoring serum magnesium levels. It is essential to divide supplementation into as many doses as tolerable for the patient to maintain steady plasma levels, as large variations may be detrimental 1. Patients should be aware that common side effects include diarrhea, abdominal cramping, and nausea, and taking the supplement with food can reduce digestive discomfort. Some key points to consider when treating hypomagnesemia include:
- Monitoring serum magnesium levels regularly to adjust the treatment dose as needed
- Being aware of the potential for gastrointestinal side effects and taking steps to mitigate them
- Considering the use of intravenous replacement for severe hypomagnesemia or in patients who cannot tolerate oral supplements
- Recognizing the importance of magnesium in various bodily functions, including energy production, protein synthesis, and neuromuscular function, and the potential consequences of deficiency, such as muscle cramps, weakness, and cardiac arrhythmias. According to the most recent study 1, the target level for plasma magnesium should be above 0.6 mmol/l, although exact target levels may vary depending on the specific condition being treated.
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). The recommended oral treatment for hypomagnesemia is not provided in the given drug labels, as they describe IV and IM administration. Key points:
- The provided drug labels do not mention oral treatment for hypomagnesemia.
- The labels describe IV and IM administration for magnesium deficiency treatment 2. The FDA drug label does not answer the question.
From the Research
Oral Treatment for Hypomagnesemia
- The recommended oral treatment for hypomagnesemia is magnesium supplements, with asymptomatic patients being treated with oral magnesium supplements 3.
- Parenteral magnesium should be reserved for symptomatic patients with severe magnesium deficiency (< 1.2 mg/dL) 3.
Bioavailability of Magnesium Preparations
- The bioavailability of magnesium preparations varies, with magnesium oxide having relatively poor bioavailability (4%) compared to magnesium chloride, magnesium lactate, and magnesium aspartate, which have higher and equivalent bioavailability 4.
- Inorganic magnesium salts, depending on the preparation, may have bioavailability equivalent to organic magnesium salts 4.
Recommended Dietary Amounts of Magnesium
- The recommended dietary amounts of magnesium have been set at 6 mg/kg day in developed countries 5.
- The magnesium requirements for optimal health in the adult population depend on various factors, including mesological and constitutional conditioning factors, and the influence of other nutrients on magnesium absorption 5.
Risks of Hypermagnesemia
- High doses of magnesium oxide can lead to hypermagnesemia, particularly in patients with chronic kidney disease (CKD) or those taking concomitant medications such as stimulant laxatives 6.
- Renal function and magnesium oxide dosage, but not age, are associated with hypermagnesemia and high serum magnesium concentration in patients taking daily magnesium oxide 6.
- In children with functional constipation treated with magnesium oxide, serum magnesium concentration increased significantly, but not critically, and was not associated with side effects of hypermagnesemia 7.