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Magnesium: The Forgotten Electrolyte—A Review on Hypomagnesemia
Open accessAbstract
Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It plays an important role in different organ systems at the cellular and enzymatic levels. Despite its importance, it still has not received the needed attention either in the medical literature or in clinical practice in comparison to other electrolytes like sodium, potassium, and calcium. Hypomagnesemia can lead to many clinical manifestations with some being life-threatening. The reported incidence is less likely than expected in the general population. We present a comprehensive review of different aspects of magnesium physiology and hypomagnesemia which can help clinicians in understanding, identifying, and treating this disorder.
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![Figure 2 Relation between urinary and plasma magnesium levels in a healthy subject on a magnesium-free diet (Adapted from Shils ME. Experimental human magnesium deficiency [13]) (Blue line—Plasma Magnesium, Red line—Urinary Magnesium).](/paper-figures/92c416b4683f4ae49229d797828faff1/magnesium-the-forgotten-electrolytea-review-on-hypomagnesemia-figure-2.jpg)
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“Magnesium deficiency may contribute to hypokalemia by enhancing renal potassium loss via disinhibition of renal outer medullary potassium channel (ROMK) in the distal nephron [41].”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [41]
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“This was to be expected, since the prevalence of hypomagnesemia is estimated to be less than 2% in the general population [2,4], and our intent was explorative.”
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Schiroli, D., Marraccini, C., Zanetti, E., Ragazzi, M., Gianoncelli, A., Quartieri, E., Gasparini, E., Iotti, S., Baricchi, R., & Merolle, L. (2021) · Diagnostics · doi:10.3390/diagnostics11040727 · Cited by 11
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“In addition, PPI usage is associated with hypomagnesemia [37], and some studies have demonstrated a link between hypomagnesemia and T2DM by altering cellular glucose transport [38].”
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Veronese, N., & Barbagallo, M. (2021) · Nutrients · doi:10.3390/nu13030847 · Cited by 11
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“The precise mechanistic underpinnings of the magnesium-arrhythmia interplay remain incompletely elucidated but may involve modulation of calcium channel function and the sodium–potassium membrane pump [11].”
BackgroundAlbert, A., Hinkel, U. P., Bohlender, T., Stieger, P., Braun-Dullaeus, R. C., & Albert, C. (2025) · Kidney Medicine · doi:10.1016/j.xkme.2025.101046 · Cited by 9
“18 Repeated intravenous (i.v.) injection of magnesium sulfate 50% (equivalent to 486 mg/20 mmol of magnesium) may be necessary to achieve a stable increase of Ca 2 + , and consecutive normalization of PTH levels.”
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Lloyd, C., Mohar, C., & Priano, J. (2022) · Journal of Emergency Nursing · doi:10.1016/j.jen.2021.12.008 · Cited by 9
Paroxysmal Tremor and Vertical Nystagmus Associated with Hypomagnesemia
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“Hypomagnesemia may have different causes, including low intake, pathological redistribution (ie, refeeding syndrome or treatment of diabetic ketoacidosis), and increased loss, for example, via the kidney (familial causes or acquired because of medication associated with hypercalcemia or as a result of alcohol abuse) o…”
Background“AMP plus”: Immunostimulant-Inspired Design Based on Chemotactic Motif-(PhHAhPH)n
Zhu, Y., Xu, Y., Yan, J., Fang, Y., Dong, N., & Shan, A. S. (2023) · ACS Applied Materials & Interfaces · doi:10.1021/acsami.3c09353 · Cited by 8
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Secondulfo, C., Vecchione, N., Russo, D., Hamzeh, S., Iacuzzo, C., Apicella, L., Pietro, R. A. D., Pisani, A., Amicone, M., Círillo, M., et al. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26072904 · Cited by 7
“…of restoring serum Mg 2+ in kidney patients: hypomagne-semia is associated with hypertension, cardiovascular disease and cerebrovascular events, and osteoporosis [4]; some authors even suggest a pre-emptive initiation of SGLT2i therapy in order to prevent the development of PTDM in KTRs [20].”
Merschmann, R., Burgmer, C., Eckert, G. P., & Wagner, A. E. (2025) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.70227 · Cited by 7
Hypomagnesemia: A Clinical and Nutritional Update
Papagiannidou, A., Mitropoulou, M., Papantzikos, K., Petropoulou, D., Tsilingiris, D., Magkos, F., & Dalamaga, Μ. (2026) · Current Nutrition Reports · doi:10.1007/s13668-026-00745-5 · Cited by 7
“Other important reasons behind poor attention on this ion include the inadequate comprehension of its physiology and the clinical presentation of hypomagnesemia appearing only when magnesium levels are significantly depleted [ 3].”
InfluentialOral magnesium reduces levels of pathogenic autoantibodies and skin disease in murine lupus
Verlato, A., Laragione, T., Bin, S., Kim, R. H., Salem, F. E., Gulko, P. S., & Cravedi, P. (2024) · BMC Immunology · doi:10.1186/s12865-024-00650-y · Cited by 7
“Magnesium has a central role in many intracellular functions [5, 6].”
BackgroundLima, F. D. S., Makiyama, E. N., Hastreiter, A. A., Castelhano, A. B. D. S., & Fock, R. A. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.01.001 · Cited by 7
Li, Q., Hu, X., Li, G., Li, D., Ao, Q., & Zhou, F. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02872-x · Cited by 6
Sankova, M. V., Kytko, O. V., Meilanova, R. D., Vasil’ev, Y. L., & Nelipa, M. V. (2020) · Research Results in Pharmacology · doi:10.3897/rrpharmacology.6.59407 · Cited by 6
“…> magnesium taurate > magnesium aspartate > magnesium aspartate + potassium aspartate > magnesium pyroglutamate (pidolate) > magnesium glycinate > magnesium citrate > magnesium orotate > magnesium lactate (Spasov and Kosolapov 2017; Ahmed and Mohammed 2019; Ates et al. 2019; Eremenko et al. 2019).”
BackgroundInfluentialHypomagnesemia in intestinal lymphangiectasia: a case report and review of the literature
Feng, H., Zou, L., Zhai, X., Zhang, S., & Li, J. (2022) · BMC Gastroenterology · doi:10.1186/s12876-022-02318-6 · Cited by 6
“In addition, one-third of the active form (as opposed to the storage form) of body magnesium is bound to albumin [3].”
BackgroundXie, J.-Z., Huang, Y., Zheng, X.-F., Feng, R., Li, X., Zheng, Z.-G., Jiang, B.-J., Du, S., Chen, H., & Xu, Y. (2024) · BMC Public Health · doi:10.1186/s12889-023-17615-2 · Cited by 6
“Thus, Mg disorder, probably owing to an excessive dietary intake of Mg, pathological problems (e.g., abnormal renal wasting), or excessive use of drugs (e.g., diuretics) [43], would give rise to serious consequences or dramatic effects on metabolism.”
BackgroundSankova, M. V., Nikolenko, V. N., Oganesyan, M. V., Sankov, S. V., Sinelnikov, M. Y., Suslov, A. V., Trishina, A. S., Zharikova, T. S., Pontes‐Silva, A., & Zharikov, Y. O. (2024) · Sport Sciences for Health · doi:10.1007/s11332-024-01179-8 · Cited by 6
“…the degree of alimentary hyomagne-semia compensation in erythrocytes in the following order: Mg aspartate + B6 > Mg lactate + B6 = Mg aspartate > Mg taurate > Mg aspartate > Mg aspartate + potassium aspar - aginate > pyroglutamate (pidol) > Mg glycinate > Mg citrate > Mg orotate > Mg lactate [91].”
Kim, O., Kim, K., Park, S., Yang, H., Kim, H., Ro, W., & Lee, C. (2023) · Journal of Veterinary Internal Medicine · doi:10.1111/jvim.16963 · Cited by 6
Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms
Qing, G., Zakaria, W. N. A., Rom, F. Z. M., Nik, W. N. F. H. W., Zulkeflee, H. A., & Rahim, S. N. A. (2025) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2554 · Cited by 5
“Magnesium deficiency may contribute to hypokalemia by enhancing renal potassium loss via disinhibition of renal outer medullary potassium channel (ROMK) in the distal nephron [41].”
Cation-Binding of Glutamate in Aqueous Solution
Friesen, S., Kruchinin, S. E., Fedotova, M. V., & Buchner, R. (2024) · The Journal of Physical Chemistry B · doi:10.1021/acs.jpcb.4c02373 · Cited by 5
The role of gut flora-driven Th cell responses in preclinical rheumatoid arthritis
Chen, S., Dan, L., Li, X., He, Q., Hu, D., & Gao, Y. (2025) · Journal of Autoimmunity · doi:10.1016/j.jaut.2025.103426 · Cited by 6
Trace element magnesium: a key player in hypertension management
Parsanathan, R. (2023) · Hypertension Research · doi:10.1038/s41440-023-01404-w · Cited by 5
Clinical Guideline for Detection and Management of Magnesium Deficiency in Ambulatory Care
Colaneri-Day, S., & Rosanoff, A. (2025) · Nutrients · doi:10.3390/nu17050887 · Cited by 5
“Traditional and current HCP training does not incorporate the identification of Mg deficit in the diagnosis of acute and chronic diseases [6].”
Laragione, T., Harris, C. L., & Gulko, P. S. (2024) · Nutrients · doi:10.3390/nu16234247 · Cited by 5
“Magnesium (Mg) is the second most abundant intracellular cation in the human body and is involved in several biochemical functions including enzymatic activity and gene transcription [5].”
Dias, R. S. C., Brito, D. J. D. A., Santos, E. M. D., Costa, R. C. D. O., Fontenele, A. M. M., Hortegal, E. V., Lages, J. S., dos Santos, A. M., Santos, E. J. F., Carneiro, É. C. R. D. L., et al. (2020) · International Journal of Nephrology and Renovascular Disease · doi:10.2147/ijnrd.s282106 · Cited by 5
Diagnosis and outpatient management of Gitelman syndrome from the first trimester of pregnancy
Lim, M., & Gannon, D. (2021) · BMJ Case Reports · doi:10.1136/bcr-2021-241756 · Cited by 5
Neurological aspects of electrolyte disorders
Howard, R., Baheerathan, A., Brown, R. L., Spillane, J. E., & Waraich, M. (2025) · Practical Neurology · doi:10.1136/pn-2023-003801 · Cited by 9
A Proposed Scale to Assess Magnesium Status Using Serum Calcium and Magnesium Ratios
Rosanoff, A., von Ehrlich, B., & Nelson, D. J. (2025) · Nutrients · doi:10.3390/nu17233671 · Cited by 4
Larimi, A. S., Jafari, H., & Sadeghzadeh, A. (2024) · JOM · doi:10.1007/s11837-024-06932-5 · Cited by 4
Genome-wide association study of serum magnesium in type 2 diabetes
Oost, L. J., Slieker, R. C., Blom, M. T., Hart, L. M. ‘., Hoenderop, J. G. J., Beulens, J. W. J., & de Baaij, J. H. F. (2024) · Genes & Nutrition · doi:10.1186/s12263-024-00738-5 · Cited by 4
“The prevalence of hypomagnesemia is between 10 and 45%, which is 10 times higher in people with type 2 diabetes mellitus compared to the healthy population [6–8].”
BackgroundFamilial hypomagnesemia with hypocalcemia: a rare cause of infantile seizures
Srinivasan, R., Ninama, A. C., Krishna, S., & Vasudevan, A. (2022) · CEN Case Reports · doi:10.1007/s13730-022-00734-x · Cited by 4
“It also regulates the movement of sodium and potassium across cell membranes [2].”
BackgroundMassive Transfusion Increases Serum Magnesium Concentration
Malinowska, J., Małecka‐Giełdowska, M., Pietrucha, K., Górska, G., Kogut, D., & Ciepiela, O. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12155157 · Cited by 4
Marushko, Y. V., Hyshchak, T. V., Dmytryshyn, O. A., Dmytryshyn, B. Y., & Myka, M. Y. (2023) · Modern pediatrics Ukraine · doi:10.15574/sp.2023.133.90 · Cited by 4
The Potential Role of Glutamate Receptors and their Antagonists or Modulators in Migraine Therapy
Tsai, C.-H., Lai, M., & Huang, C. (2025) · Current Neuropharmacology · doi:10.2174/1570159x23666250403124115 · Cited by 3
Ionized calcium and ionized magnesium disturbances in dogs and cats with septic peritonitis
Debie, C., Giberto, L., Noël, S. M., Paepe, D., & Gommeren, K. (2025) · Frontiers in Veterinary Science · doi:10.3389/fvets.2025.1550701 · Cited by 3
“Conditions such as trauma (71), neoplasia (72), renal failure (17, 72, 73), hyperthyroidism (64), pancreatitis (24, 74–76), hypoadrenocorticism (72), and diabetes mellitus (24, 77, 78), are known to affect iCa and iMg values.”
InfluentialPasqualetti, S., Chibireva, M. D., Birindelli, S., & Panteghini, M. (2021) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2021.03.016 · Cited by 3
Formulation and evaluation of magnesium sulphate nanoparticles for improved CNS penetrability
Mathew, A. A., Mohapatra, S., & Panonnummal, R. (2022) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-022-02356-7 · Cited by 3
“Magnesium oxide, carbonate, sulphate, citrate, lactate, chloride and aspartate are commonly available magnesium supplements (Ahmed and Mohammed 2019).”
BackgroundTirani, S. A., Rouhani, P., & Saneei, P. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf014 · Cited by 3
Magtaan, J. K., Fitzpatrick, B., & Murphy, R. P. (2020) · Current Pharmaceutical Design · doi:10.2174/1381612826666201210112119 · Cited by 3
Public Health Perspective on Magnesium
Šoher, L., & Banjari, I. (2021) · Journal of Applied Health Sciences · doi:10.24141/1/7/2/10 · Cited by 4
Hypomagnesaemia – One Cause To Remember!
Viegas, A. F., Lopes, A. F. M., de Almeida, C. L., Ennis, G., & Tavares, J. P. (2022) · European Journal of Case Reports in Internal Medicine · doi:10.12890/2022_003637 · Cited by 3
“Hypokalaemia is frequently seen resulting from different mechanisms: hypoparathyroidism due to impaired PTH release caused by hypomagnesaemia; bone-PTH resistance; or vitamin D deficiency caused by decreased vitamin D renal conversion, either by decreased PTH levels or by a direct effect of magnesium depletion on the…”
BackgroundInfluential
Metadata
- Authors
- Ahmed, F., & Mohammed, A.
- Affiliations
- OSF Saint Anthony Medical Center (US)
- Advocate Illinois Masonic Medical Center (US)
- Corresponding author
- Ahmed, Faheemuddin
- ORCID
- Mohammed, Abdul
- Venue
- Medical Sciences
- Publisher
- MDPI AG
- Published
- 2019-04-04
- Volume
- 7
- Issue
- 4
- Pages
- 56
- ISSN
- 2076-3271 (ISSN-L)
- PMC
- PMC6524065
- OpenAlex
- W2926579042
- Cited by
- 186
- References
- 46
- Citations by year
- 2026: 14 · 2025: 28 · 2024: 31 · 2023: 32 · 2022: 28 · 2021: 29 · 2020: 24
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Medical Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Magnesium in Health and Disease
- Physical Sciences › Materials Science › Biomaterials › Magnesium Alloys: Properties and Applications
- Physical Sciences › Materials Science › Materials Chemistry › Magnesium Oxide Properties and Applications
- Keywords
- magnesium, hypomagnesemia, magnesium physiology, electrolytes, intracellular cations, clinical features, incidence, treatment
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