Treatment of Oral Paresthesia Related to Magnesium Deficiency
For oral paresthesia potentially related to magnesium deficiency, oral magnesium supplementation with organic magnesium salts (aspartate, citrate, lactate, or glycinate) at a dose of 600-800 mg daily is the recommended first-line treatment. 1
Diagnosis and Assessment
Before initiating treatment, confirm magnesium deficiency through:
- Serum magnesium levels (target >0.6 mmol/L or >1.5 mg/dL)
- Assessment for risk factors:
- Chronic gastrointestinal disorders
- Malabsorption syndromes
- Short bowel syndrome
- Chronic diarrhea
- Medication use (PPIs, diuretics)
Treatment Algorithm
First-Line Treatment: Oral Supplementation
Preferred formulations (higher bioavailability):
- Magnesium glycinate: 600-800 mg daily 1
- Magnesium citrate: 12-24 mmol daily
- Magnesium aspartate or lactate
Alternative formulation:
- Magnesium oxide: 160 mg capsules (4 mmol), total of 12-24 mmol daily, preferably at night 1
For Severe Deficiency or Inability to Tolerate Oral Supplements
- IV magnesium replacement:
Monitoring and Follow-up
- Recheck magnesium levels after 1-2 weeks of oral therapy 1
- For IV supplementation, monitor levels every 4-6 hours during acute correction 1
- Continue supplementation until target level >0.6 mmol/L is achieved 1
Special Considerations
Cautions
- Renal impairment: Avoid magnesium supplementation in patients with severe renal impairment (creatinine clearance <20 mg/dL) due to risk of hypermagnesemia 1
- Gastrointestinal side effects: Oral magnesium supplements can cause diarrhea; liquid or dissolvable products are usually better tolerated than pills 3
- Dosage adjustment: Start with recommended daily allowance (350 mg daily for women; 420 mg daily for men) and increase gradually according to tolerance 3
Potential Side Effects of Over-Supplementation
- Gastrointestinal intolerance
- Muscle weakness
- Flushing
- Hypotension
- Bradycardia
- Blurred vision
- Cognitive effects 3
Alternative Treatments for Persistent Symptoms
If oral paresthesia persists despite adequate magnesium supplementation, consider:
- Evaluation for other electrolyte imbalances (calcium, potassium)
- Assessment for psychogenic causes of oral paresthesia 4
- Investigation of other neurological conditions
Evidence Strength
The recommendation for oral magnesium supplementation is supported by clinical guidelines from the European Society for Clinical Nutrition and Metabolism and the Kidney International guideline society 1. While there are limited studies specifically on oral paresthesia and magnesium deficiency, evidence supports that magnesium deficiency can lead to neurological symptoms including paresthesias, and that oral supplementation can effectively correct magnesium deficiency 5.