Treatment of magnesium deficiency

Prevention of magnesium deficiency requires consideration of several factors: first the normal magnesium requirements, second the increased requirements and increased losses due to the disease state, and finally iatrogenic magnesium depletion and redistribution.

The treatment of magnesium deficiency is summarized in Tables».

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Table 3 Treatment of hypomagnesemia

Care should be taken when using magnesium therapy, particularly with large intravenous doses or when there is coexisting renal failure. It is advisable to monitor vital signs, respiratory rate, and the electrocardiogram during acute magnesium replacement, and to measure plasma levels of magnesium, calcium, and potassium. Magnesium may cause some reduction in vasomotor tone and myocardial contraction, but overall there is generally little detrimental cardiovascular effect. Signs of hypermagnesemia should be sought and are usually apparent when the serum magnesium exceeds 3 mmol/l. They include loss of deep tendon reflexes, lethargy, muscle weakness leading eventually to muscle paralysis, and respiratory failure. Cardiovascular effects include hypotension from reduced vascular resistance and cardiac conduction changes including prolonged sinoatrial conduction time, atrioventricular refractory period, and PR and AV intervals, which explain the antiarrhythmic effects. If the above signs develop, administration of magnesium should cease and the serum level should be measured.

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