A retired attending advised me to always keep my hopes low as a key to happiness … and so I keep my hopes low – just like the Magnesium (Mg) levels of most inpatients I see.
It’s an uphill battle to bring low Mg levels up AND to keep them up there. Infusing IV Mg gives a nice temporary bump and if you recheck Mg levels too soon within 24-36 hours , you might even pat yourself on your back for a job well done. But by day 3 when a lot of it is lost in urine & the rest achieves equilibrium with body storage, it often feels like back to square one !
Besides advising on dietary sources , prescribing oral magnesium supplements is the next step. There are two types – organic and inorganic . Organic ones like Magnesium Glycinate & Magnesium Citrate have less elemental Magnesium per gram but absorption is better , the opposite being true for inorganic supplements like Magnesium Oxide or Chloride. This study found that organic Magnesium supplements or even mixed Mg supplements are more soluble and show a greater rise in Mg levels than inorganic ones despite carrying less elemental Mg.
I usually start with twice a day (BID) dosing , then cut back or escalate frequency to TID depending on if they have diarrhea or no, since diarrhea only makes them lose more Mg. Also review your patients other medications to see if they interfere with Mg absorption & excretion and make adjustments if possible !
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