Causes of hypomagnesemia

Causes of hypomagnesemia
Author
Zalman S Agus, MD
Section Editor
Stanley Goldfarb, MD
Deputy Editor
John P Forman, MD, MSc
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2012. | This topic last updated: Jun 26, 2012.
INTRODUCTION Hypomagnesemia is a common entity occurring in up to 12 percent of
hospitalized patients [1]. The incidence rises to as high as 60 to 65 percent in patients in an
intensive care setting in which nutrition, diuretics, hypoalbuminemia, and aminoglycosides may
play important roles [2-5]. The kidney can, in the presence of magnesium depletion, lower
magnesium excretion to very low levels; the stimulus for this response is a fall in the plasma
magnesium concentration. (See "Regulation of magnesium balance".)
There are two major mechanisms by which hypomagnesemia can be induced: gastrointestinal or
renal losses. Regardless of the cause, hypomagnesemia begins to occur after a relatively small
magnesium deficit, because there is little rapid exchange of extracellular magnesium with the
much larger bone and cell stores.
Hypomagnesemia is often associated with hypokalemia due to urinary potassium wasting and
hypocalcemia due both to lower parathyroid hormone secretion and end-organ resistance to its
effect. (See "Signs and symptoms of magnesium depletion".)
GASTROINTESTINAL LOSSES Gastrointestinal secretions contain some magnesium, and
potential losses are continuous and not regulated. Although the obligatory losses are not large,
marked dietary deprivation can lead to progressive magnesium depletion.
Magnesium losses from both the upper and lower gastrointestinal tract can induce
hypomagnesemia. In general, magnesium depletion is more commonly due to diarrhea than to
vomiting [5]. This is because the magnesium content of lower tract secretions is significantly
higher (up to 15 meq/L versus approximately 1 meq/L for upper tract). Common settings in
which hypomagnesemia may be seen are when intestinal secretions are incompletely reabsorbed,
as with most disorders of the small bowel, including acute or chronic diarrhea, malabsorption
and steatorrhea, and small bowel bypass surgery.
A much rarer disorder is an inborn error of metabolism characterized by a selective defect in
magnesium absorption (primary intestinal hypomagnesemia). This disease presents in the
neonatal period with hypocalcemia responsive to magnesium administration [6]. In some

instances, the defect appears to have a X-linked recessive inheritance, but others have described
autosomally recessive inheritance with linkage to chromosome 9 [7].