Magnesium Deficiency


Adults with certain illnesses, chronic conditions, or taking medicines that are associated with magnesium depletion may be at particular risk of developing a
magnesium deficiency.1-11


Medical conditions which may be associated with magnesium loss1-5, 10


GI Loss/Malabsorption

  • Extensive bowel resection
  • Intestinal or biliary fistulas
  • Celiac disease
  • Ulcerative colitis
  • Crohn’s Disease
  • Chronic/excessive diarrhea/vomiting

Renal Causes

  • Chronic pyelonephritis
  • Postobstructive nephropathy

Inherited Disorders

  • Gitelman’s syndrome (hypocalcemia and hypomagnesemia)
  • Bartter’s syndrome

Endocrine

  • Hyperaldosteronism
  • Hyperthyroidism
  • Hyperparathyroidism
  • Poorly controlled diabetes mellitus

Nutritional

  • Alcoholism and alcohol cirrhosis
  • Protein and calorie malnutrition
  • Prolonged parenteral fluid without magnesium

Medications which may be associated with magnesium loss1-11


Anti-Infectives

  • Aminoglycosides
    • Gentamicin
    • Amikacin
    • Tobramycin
  • Ticarcillin/clavulanate
  • Pentamidine
  • Amphoterocin B
  • Foscarnet

Loop/Thiazide Diuretics

  • Bumetanide
  • Chlorthalidone
  • Ethacrynic acid
  • Furosemide
  • Hydrochlorothiazide

Antineoplastics

  • Aldesleukin
  • Carboplatin
  • Cisplatin
  • Cetuximab
  • Panitimumab

Proton Pump Inhibitors

  • Esomeprazole
  • Pantoprazole
  • Omeprazole
  • Rabeprazole
  • Lansoprazole
  • Dexlansoprazole

Immunosuppressants

  • Cyclosporine
  • Tacrolimus

Other

  • Theophylline

Additional Information

  • Patients treated with digoxin and other medications associated with magnesium loss or hypomagnesemia may be at an increased risk for serious side effects1, 4, 8, 11
  • Long-term use of diuretics may also cause hypokalemia. Potassium depletion is associated with diminished magnesium reabsorption and may lead to increased magnesium excretion2

References

  1. Whang R, Hampton EM, Whang DD. Magnesium homeostasis and clinical disorders of magnesium deficiency. Ann Pharmacother. 1994;28(2): 220-226.
  2. Maher TJ. Medications, alcohol consumption and magnesium: ensuring adequate intake of oral magnesium. The Magnesium Report Clinical, Research, and Laboratory News for Cardiologists. Second Quarter 2000. Available at: http://www.mgwater.com/adequate.shtml Accessed 6/4/2014.
  3. National Institutes of Health, Office of Dietary Supplements. Available at: http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/. Accessed 05/2014.
  4. Dipalma JR. Magnesium Replacement Therapy. Am Fam Physician. 1990;42(1):173-176.
  5. Martin KJ, Gonzalez EA, Slatopolsky E. Clinical consequences and management of hypomagnesemia. J Am Soc Nephrol. 2009;20(11):2291-2295.
  6. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol .2011; 27: 180–185.
  7. O’Neill LW, Culpepper BL, Galdo JA. Long-term consequences of chronic proton pump inhibitor use. US Pharm. 2011;27:180–185.
  8. US Department of Health and Human Services, Drug Safety Communication. FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of proton pump inhibitor drugs (PPIs). 03 March 2011; Available at: http://www.fda.gov/drugs/drugsafety/ucm245011.htm. Accessed 06/4/2014.
  9. Izzedine H, Bahleda R, Khayat D, et al. Electrolyte disorders related to EGFR-targeted drugs. Crit Rev Oncol Hematol. 2010; 73(3): 213-219.
  10. Saif MW. Management of hypomagnesemia in cancer patients receiving chemotherapy. J Support Oncol. 2008;6: 243-248.
  11. Atsmon J, Dolev E. Drug-induced hypomagnesaemia. Drug Saf.2005;28(9):763-788.