Normal therapeutic dosages of aminoglycosides can cause hypomagnesemia in more than one-third of patients. Hypomagnesemia occurs early in therapy, results in renal Mg++ wasting and may produce hypocalcemia and hypokalemia.

We infer from these studies that aminoglycosides inhibit hormone-stimulated Mg2+ absorption in the distal convoluted tubule that may contribute to the renal magnesium wasting frequently observed with the clinical use of these antibiotics.

It is concluded that gentamicin-induced hypomagnesemia may occur more commonly than has been previously appreciated. Serial monitoring of serum magnesium in patients receiving gentamicin is recommended.

Drugs frequently associated with renal magnesium wasting include loop and thiazide diuretics, aminoglycosides, amphotericin, cisplatin, cyclosporine, pentamidine and foscarnet[12-14]. An increasing number of reports have recently identified proton pump inhibitors (PPIs) as a cause of hypomagnesemia[15-21].

Treatment of Hypomagnesemia Treatment with magnesium salts is indicated when magnesium deficiency is symptomatic or the magnesium concentration is persistently < 1.25 mg/dL (< 0.50 mmol/L). Patients with alcohol use disorder are treated empirically. In such patients, deficits approaching 12 to 24 mg/kg are possible.

Hypomagnesemia is typically treated with oral magnesium supplements and increased intake of dietary magnesium. An estimated 2 percent of the general population has hypomagnesemia. This percentage is much higher in hospitalized people.

When evaluating causes of hypokalemia, a physician must also address other underlying causes of the hypokalemia, such as volume depletion and hypomagnesemia. Asymptomatic and mild hypokalemia can be treated with a potassium-rich diet, whereas symptomatic or severe hypokalemia requires oral or IV potassium [8, 9].

Hypomagnesemia can cause cardiac arrhythmia. Changes in electrocardiogram findings include prolongation of conduction and slight ST depression, although those changes are nonspecific. Patients with magnesium deficiency are particularly susceptible to digoxin-related arrhythmia.

Hypomagnesemia seldom occurs in an isolated situation so that it is difficult to document ECG changes in hypomagnesemia (isolated). It is often associated with other electrolyte imbalances like hypokalemia and hypocalcemia which confound the ECG changes. Nevertheless, there have been case reports of isolated hypomagnesemia with ECG changes.

Aminoglycosides produce disturbances in electrolyte homeostasis, resulting in hypokalemia, hypomagnesemia, and hypocalcemia. The mechanisms of the aminoglycoside-induced syndome of hypokalemic metabolic alkalosis associated with hypomagnesemia are not clear.

In most patients, symptomatic hypomagnesemia was transient, and improved after magnesium provision. Only one child with congenital renal magnesium wasting and two with primary hypomagnesemia needed long-term magnesium treatment. MeSH terms

Normal serum magnesium levels are generally considered to be 0.8 – 1.0 mmol/L. Hypomagnesaemia, defined as a level < 0.8 mmol/L, is associated with QT interval prolongation and an increased risk of ventricular arrhythmias. ECG changes in isolated hypomagnesaemia