Endocrine Abstracts

Magnesium disorders are common in clinical practice. Hypomagnesemia is seen in inherited disorders, with excessive gastrointestinal or renal losses and due to medications. Replacement of magnesium can be challenging, with oral replacement strategies being generally more effective at slowly replacing body storages and intravenous (iv) replacement being more effective at treating life-threatening and severe cases of hypomagnesemia.

Objective, material and methods: To analyze clinical history and evolution of a group of patients with severe hypomagnesemia who received treatment with iv magnesium in the Endocrinology and Nutrition day hospital center of a tertiary hospital during 2023.

Results: 7 patients. 5 men. Mean age: 62.6 years. Follow-up 40.9 months. Hypomagnesemia causes: - Short intestine syndrome (5), etiology: Crohn disease (3), surgery complications (1) and radical enteritis (1). - Chronic diarrhea syndrome with Gitelman syndrome (1). - Malabsortion syndrome post bariatric surgery (1). No diagnosis of severe hypomagnesemia due to pharmacology causes. 3/7 with ileostomy. Two patients received additional treatment with iv suerotherapy weekly. One received domiciliary daily suerotherapy through PICC. 3/7 with chronic renal disease. 4/7 chronic consumers of PPIs at start of follow-up. 3/7 maintained it at the end of follow-up as part of high debit ileostomy treatment. 2/7 went to the emergency department during follow-up for neurological complications in the form of vegetative symptoms followed by distal paresthesias and dizziness. The most frequent frequency of infusion was once a week, except for one patient who received iv magnesium infusion every 4 days. As for the amount of magnesium administered, the mean was 585 mg iv per week, with a maximum of 900 mg iv per week and a minimum of 300 mg iv every 15 days. All patients received oral supplementation with magnesium, on average 745 mg/day. 5/7 received oral calcium supplementation, mean 960 mg/day. 3/7 were receiving oral potassium supplementation, mean 2400 mg/day. Magnesium levels improving during the follow-up (initial compared to last visit) [0.91 vs 1, 44 mg/dl (t -3.17 p.019)]. 3/7 treated with oral nutritional supplements because of malnutrition (GLIM criteria). No significant changes in weight and BMI during follow-up.

Conclusions: In our series, the pathology that led to treatment with iv magnesium and high-dose oral supplementation was mainly due to digestive and malabsorption causes. Close monitoring, as well as joint treatment with iv magnesium and high-dose oral supplementation, achieved significant improvements in magnesium blood levels in our sample.