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Guidelines for Magnesium Replacement in Adults:

The normal laboratory range for magnesium is 1.6 – 2.3 mg/dl. In some clinical situations, such as arrhythmias, it may be desirable to
maintain magnesium levels > 2. For mild hypomagnesemia (1.3-1.5), oral agents may be used.

Table I: MAGNESIUM REPLACEMENT IN ADULTS

Indication Dose
Mild- moderate hypomagnesemia (Mg 1-1.5 Administer 1-2 tablets magnes ium oxide daily-qid as tolerated OR
mg/dl) and asymptomatic Administer 1-2 grams magnesium sulfate IV over 1 hour.

Severe hypomagnesemia (Mg<1 or <1.3 with Administer 3-4 grams magnesium sulfate IV over 2 hours. Check Mg level
symptoms) 1 hour after the infusion and redose as necessary.

Empiric dosing recommendations are for adults with normal organ function and are not meant to replace clinical judgement for individual patient care.
Dosing ranges may differ from manufacturers’ labeling for magnesium supplementation.

Policy Statements:
1. Do not exceed intravenous infusion rates of 150 mg/min.
2. The maximum concentration dispensed for an infusion will be 200 mg/mL.
3. Magnesium must be ordered in terms of mg or grams of the salt form.

Oral magnesium -containing agents available on The Medical University of South Carolina Formulary of Accepted Drugs include:
Table II: MAGNESIUM-CONTAINING ORAL PRODUCTS
Formulary Product Strength Elemental Magnesium
content
Magnesium gluconate liquid 1000 mg/5 mL 58.5 mg
(Magonate)
Magnesium oxide 400 mg 241 mg
(Mag-ox)

Clinical Practice Points:

1. The suggested concentration for magnesium infusions is 10 mg/mL (1 gram/100 ml).
2. Serum magnesium levels may not reflect total body magnesium content since only 1-2% of magnesium is distributed in
extracellular fluid. Therefore, multiple doses may be required to replete magnesium stores.
3. Serum potassium levels must be in the normal range to effectively replete serum magnesium.
4. Replacement over 3 to 5 days may be necessary to replete total magnesium stores.
5. Maintenance doses may be necessary in patients with continued magnesium losses.
6. Rapid intravenous bolus may cause flushing, sweating or a sensation of warmth.
7. Caution should be taken in patients with renal impairment. These patients may require lower doses and more frequent monitoring.
8. Oral magnesium product intake may be limited by diarrhea. As a result, smaller doses given more frequently may be more
effective.
9. Intramuscular (IM) administration of magnesium should be reserved for situations in which peripheral venous access is not readily
obtainable since this route of administration may be painful, often requires multiple punctures and offers no therapeutic advantage
over intravenous administration.

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