Magnesium levels are not routinely included in standard chemistry panels, so abnormalities of magnesium frequently go unrecognized. The reference range of serum magnesium concentration is 1.7 to 2.2 mg/dL (1.5-1.7 mEq/L, or 0.750.95 mmol/L). The most common cause of hypermagnesemia is excess magnesium intake in a patient with chronic kidney disease (Table 15-19). Mild hypermagnesemia can also be seen in Addison's disease, hypothyroidism, and lithium intoxication. Symptoms of hypermagnesemia are seen with levels greater than 4 to 6 mg/dL.

Hypomagnesemia is more common than hypermagnese-mia. The three mechanisms causing hypomagnesemia are reduced intestinal absorption from malnutrition or malabsorption, increased urinary losses, and intracellular shifts. Hypomagnesemia is typically associated with alcohol abuse, hypokalemia, hypocalcemia, chronic diarrhea, and ventricular arrhythmias. Symptoms occur with serum concentrations less than 1 mEq/L. Clinically, hypomagnesemia is associated with neuromuscular hyperirritability, including tremors, tetany, and rarely, seizures. In distinguishing renal wasting from extrarenal losses as the cause of hypomagnesemia, a 24-hour urine excretion of greater than 24 mg or a spot urine fractional excretion of magnesium greater than 2% suggests that the cause of hypomagnesemia is excessive renal losses. Drugs that cause hypomagnesemia include loop and thia-zide diuretics (but not potassium-sparing diuretics), cisplatin, aminoglycosides, pentamidine, and cyclosporine.

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