Magnesium is crucial for enzymatic and genetic functions, and demand increases for both the mother and the foetus during pregnancy. Inadequate magnesium intake is linked to adverse outcomes, including foetal growth restriction and preeclampsia. This narrative review characterizes the global prevalence of insufficient magnesium intake and status among pregnant women and examines its relationship with deficiency symptoms and preeclampsia. Current magnesium requirements based on recent studies and public health guidelines to identify new hallmarks for prevention and treatment are also assessed. A literature search over the past five years revealed evidence of widespread dietary magnesium inadequacy among pregnant populations. In the absence of a validated, pregnancy-specific biomarker, the true prevalence of physiological magnesium deficiency remains difficult to establish. Serum magnesium levels often appear normal despite this dietary shortfall, which may mask an underlying insufficiency. International guidelines differ on routine supplementation, and current evidence does not support universal supplementation for all pregnant women; targeted supplementation may be warranted for those with documented insufficiency or recognized risk factors, while ensuring adequate magnesium status through a varied diet remains the appropriate strategy for the broader population. Persistent dietary inadequacy nonetheless represents a significant public health concern. Current research confirms that magnesium sulphate (MgSO4) remains the cornerstone pharmacological intervention for preeclampsia with severe features and eclampsia, and its use has been associated with a significant reduction in maternal and foetal morbidity. Further prospective research is needed to clarify pregnancy-specific magnesium requirements, validate diagnostic biomarkers, and solidify clinical guidelines and best practices for pregnancy nutrition.

Contrast-induced nephropathy (CIN) remains a frequent and clinically significant complication following percutaneous coronary intervention (PCI), particularly in patients with acute coronary syndromes (ACS). In this study of 2,696 ACS patients undergoing PCI, we investigated the association between baseline serum magnesium (Mg) levels and development of CIN. CIN occurred in 27.2% of patients. Those who developed CIN were older and had higher rates of male gender, diabetes, STEMI, Killip class >1, and contrast volume, along with lower left ventricular ejection fraction. Serum Mg levels were significantly lower in the CIN group (1.826±0.208 vs. 2.091±0.183 mg/dL, p<0.001). In addition, patients were stratified into quintiles based on serum Mg levels and a clear stepwise increase in the incidence of CIN with decreasing Mg levels was demonstrated (Q5: 8.8%, Q4: 13.9%, Q3: 21.9%, Q2: 48.8%, Q1: 57.7%; p for trend <0.001). In ROC curve analysis, Mg level <1.92 predicted CIN with 72.1% sensitivity and 73.2% specificity. Mg <1.92 was found as an independent predictor of CIN in logistic regression analysis (OR: 2.992, 95% CI: 1.611-5.232, p<0.001). These findings suggest that serum Mg may serve as a novel biomarker for CIN risk stratification. Further studies are warranted to clarify the role of Mg screening and supplementation in reducing CIN risk among ACS patients.

Magnesium is believed to have a positive and protective effect on inner ear disorders. We conducted a systematic literature search on the topic. The mesh terms "magnesium", "tinnitus", "sudden hearing loss", "vestibular disorders", "ototoxicity", and "otoprotection" were used for the Medline search. Based on this approach, a narrative review with a structured literature search was conducted. There is good evidence that supplementation with >200 mg magnesium daily protects against the development of age-related hearing loss. A similar protective effect can be assumed for protection against noise, thus the dietary supplement can also be used on an evidence-based basis in addition to other basic measures (hearing protection, noise level reduction). In cases of acute hearing loss and tinnitus, there is evidence that magnesium may have additional benefits alongside basic therapy (corticosteroids, CO2 inhalation). Derived from the use of magnesium in migraine treatment, there are individual studies (phase II, case series) that report positive effects on vestibular disorders with 1-2 g magnesium sulfate as intravenous treatment for acute situations and 400 mg oral magnesium for prophylaxis. There are only case reports on the prevention of cisplatin ototoxicity by magnesium. Despite a wealth of experimental data, the evidence for the clinical benefits of magnesium in otology is limited. Good data is available exclusively for the prevention of presbycusis. Any other therapeutic use must still be classified as experimental/individual.

Elevated blood pressure (BP) is a key modifiable cardiovascular risk factor. In low-risk individuals, guidelines recommend lifestyle interventions before pharmacotherapy. Evidence for magnesium taurate-potassium citrate supplementation in this setting is lacking. This prospective, single-arm observational study enrolled 121 adults with elevated BP or stage 1 hypertension and low cardiovascular risk (SCORE2/SCORE2-OP), per 2024 ESC guidelines, who declined antihypertensive drugs. All received lifestyle counselling plus magnesium taurate-potassium citrate (121 mg elemental magnesium, 180 mg elemental potassium daily) for three months. The per-protocol cohort included 110 patients. Primary outcomes were BP changes at work, at home (HBPM), and ambulatory BP (ABPM). Secondary outcomes were pulse-wave velocity (PWV), augmentation index (AIx), renal function, and serum electrolytes. At three months, BP at work fell by -12/-9 mmHg, HBPM by -11/-8 mmHg, and ABPM by -11/-8 mmHg (all p<0.001). PWV and AIx improved by -0.9 m/s and -4.0% (p<0.001). Serum magnesium rose by +0.1 mg/dL (p=0.003) without changes in sodium, potassium, or renal function. No serious adverse events occurred. In low-risk adults with elevated BP, magnesium taurate-potassium citrate plus lifestyle advice significantly reduced BP and arterial stiffness over three months, supporting magnesium taurate-potassium citrate as a safe non-pharmacological option. As this was a single-arm observational study with routine lifestyle counselling, causal inference was limited, underscoring the need for randomized trials.

Asthma exacerbations are a frequent cause of paediatric intensive care admissions, and early identification of patients at risk of respiratory failure is essential. Because direct ionized magnesium measurement is not routinely available, we evaluated whether estimated ionized magnesium derived from routinely available biochemical data was associated with subsequent invasive mechanical ventilation. We conducted a retrospective observational study of children admitted to a paediatric intensive care unit in Japan between 2016 and 2024 with asthma. Primary exposure was considered as the admission-phase estimated ionized magnesium value, defined as the earliest available value before initiation of invasive ventilation, and applied consistently to ventilated and non-ventilated children. The primary outcome was the need for mechanical ventilation. Receiver operating characteristic analysis and multivariable logistic regression were used to evaluate the predictive performance of estimated ionized magnesium while adjusting for arterial pH and arterial carbon dioxide tension. Among 115 eligible children, 51 (44.3%) required invasive mechanical ventilation. Estimated ionized magnesium was lower in ventilated than in non-ventilated children (median 0.467 vs 0.632 mmol/L; p < 0.001). The area under the receiver operating characteristic curve was 0.90, with a 95% confidence interval of 0.83 to 0.96. Each 0.1-mmol/L decrease in estimated ionized magnesium remained associated with higher odds of mechanical ventilation after adjustment for pH and arterial carbon dioxide tension (adjusted odds ratio: 9.46; 95% confidence interval: 3.94 to 22.71; p < 0.001). Admission-phase estimated ionized magnesium was strongly associated with invasive mechanical ventilation in children with asthma exacerbations and may provide a practical early risk marker.

The objective of this study was to investigate the effects of intravenous magnesium sulfate (MgSO4) administration on core body temperature (BT) changes in patients undergoing laparoscopic gynaecological surgery under propofol-based total intravenous anaesthesia (TIVA). Data from 120 female patients, aged 20-65, who underwent laparoscopic gynaecological surgery between March 2021 and February 2024, were analysed retrospectively. Patients were divided into Mg (n=49) and non-Mg (n=71) groups. The Mg group received MgSO4 (50 mg/kg in 100-mL isotonic saline over 15 minutes) during induction, followed by a continuous infusion (15 mg/kg/h). Core BT was recorded using tympanic thermometer and oesophageal probes: pre-anaesthesia (BT0), 5 minutes post-induction (BT5), every 15 minutes (BT15 ~ BT105), and at emergence (BT120). All patients were warmed using both a circulating-water mattress and a forced-air warming blanket. BT0 was comparable between groups. BT decreased over time in both groups (p < 0.001). The Mg group had significantly lower BT at BT5 (p = 0.031), BT15 (p = 0.004), BT30 (p = 0.011), and BT45 (p = 0.016). However, the rate of temperature change over time between groups was comparable. The incidence of post-anaesthetic shivering was significantly lower in the Mg group (19.7% vs 6.1%, p = 0.036). During propofol-based TIVA, MgSO4 administration reduced BT at early time points during surgery, while the rate of temperature change over time was not significantly affected by MgSO4 administration. Notably, the incidence of shivering was significantly lower in the Mg group.

Triglyceride-glucose index (TyGI) is a novel biomarker for diagnostic and prognostic processes. TyGI, together with magnesium level and The Charlson Comorbidity Index (CCI; used to predict long-term survival), is associated with morbidity and mortality. As type 2 diabetes mellitus (T2DM) is associated with hypomagnesaemia, magnesium may therefore be related to TyGI and CCI in patients with T2DM. To compare hypomagnesemia and normomagnesemia in terms of TyGI and CCI, and to investigate the correlation of magnesium with TyGI and CCI in patients with T2DM. T2DM patients (n=194) were divided into hypomagnesaemia (n=58) and normomagnesaemia (n=136) groups depending on serum magnesium level. TyGI was calculated with the formula, Ln[fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2]. TyGI, CCI, and laboratory parameters were compared between the groups. Correlation analysis was performed between magnesium and other parameters. There was no significant difference between the groups in terms of age, gender, BMI, T2DM duration, medication, comorbidities, or laboratory parameters (p>0.05). However, the hypomagnesaemia group had significantly increased TyGI (p=0.014) and CCI (p=0.044). There was also a significant negative correlation between magnesium and parameters including T2DM duration (r:-155; p=0.031), glucose (r:-214; p=0.003), HbA1c (r:-195; p=0.007), TyGI (r:-0.207; p=0.004), and CCI (r:-0.177; p=0.014). TyGI and CCI are increased in T2DM patients with hypomagnesaemia, and magnesium is associated with TyGI and CCI. These novel findings should be further investigated in future studies.

Studies on magnesium and bone health in the literature are conflicting. This study was conducted to evaluate the relationship between Magnesium Deficiency Score (MDS) and indicators of hip bone health in adults. This study analysed data from the NHANES in 13,259 US adults aged ≥20 years. Outcome measures included bone mineral density (BMD) (total femur, femoral neck, trochanter, intertrochanter, and Ward's triangle), osteoporosis, history of hip fracture, and FRAX (Fracture Risk Assessment Tool) score. Weighted linear regression and logistic regression models were used to assess the association between MDS and the outcomes. Trend tests were also performed to analyse the presence of a dose-response relationship. Subgroup analyses were performed by age and sex. After adjusting for all covariates, we found a significant age-stratified effect between MDS and hip bone health. In the elderly population aged ≥60 years, there was a higher risk of decline in Ward's triangle and femoral neck BMD, a higher risk of osteoporosis (OR =1.27, 95% CI: 1.07, 1.50; P trend =0.006), and higher FRAX scores as MDS scores increased. However, this negative effect was significantly attenuated in individuals <60 years. No association was found between MDS and a history of hip fracture. In addition, no sex-stratified effect was found between MDS and the outcome measures described above. The risk of severe magnesium deficiency significantly affects hip bone health in older adults, increasing the risk of subsequent fractures. Future studies should explore more detailed mechanisms associated with the role of magnesium in skeletal physiology and pathology.

Magnesium has been used as an adjuvant to general anaesthesia owing to its multiple benefits, including potentiating the action of rocuronium. However, magnesium may affect neostigmine-induced neuromuscular blockade recovery. The effects of intraoperative magnesium administration on residual neuromuscular blockade (RNMB) were investigated. This retrospective study reviewed the data of adult patients who underwent general anaesthesia with rocuronium as the neuromuscular blocking agent and neostigmine as the reversal agent, between 2018 and 2020. RNMB was defined as the administration of an additional reversal agent (neostigmine or sugammadex) in the post-anaesthesia care unit. The incidence of RNMB was compared between magnesium and control groups, and logistic regression analysis identified risk factors. Of 61,471 patients, 23,523 were included in the logistic regression analysis. After propensity score matching, 5166 patients from each group were compared, and RNMB incidence was comparable between the magnesium and control groups. In the logistic regression analysis, the risk factors for RNMB were older age (odds ratio: 1.02; 95% confidence interval: 1.01-1.03; p<0.001), male gender (1.72; 1.33-2.23; p<0.001), higher American Society of Anesthesiologists physical status (2.08; 1.54-2.82; p<0.001), limb surgery (1.46; 1.01-2.12; p=0.042), volatile anaesthetics, sevoflurane (1.84; 1.27-2.66; p=0.001), and intraoperative hypothermia (1.58; 1.13-2.23; p=0.008). Magnesium increased the risk of RNMB in patients anesthetized by propofol (2.22; 1.46-3.38; p<0.001) and sevoflurane (2.57; 1.60-4.11; p<0.001), but not desflurane (p≥0.05). Intraoperative magnesium increases the risk of RNMB in patients anesthetized with propofol and sevoflurane, and should be used with caution depending on the type of general anaesthetic agent administered.

Hypomagnesemia, a common condition, frequently goes unnoticed due to varying symptom severity. In the hospital setting, the link between adverse drug reactions and hypomagnesemia is not always clear, and some drug labels omit this risk, compounding the potential danger. We conducted a cross-sectional study by mining data from the FDA Adverse Event Reporting System (FAERS) covering Q1 2004 to Q4 2023. Using the Medical Dictionary for Regulatory Activities, we identified cases of hypomagnesemia, determined the signal drugs causing hypomagnesemia based on the drug name, and employed descriptive and disproportionality analysis methods for signal detection. From 17,381,220 adverse event reports, 11,228 individual safety reports (ISRs) involving hypomagnesemia were identified. Omeprazole led with 1,556 reports (20.75%), followed by pantoprazole, panitumumab, cetuximab, and esomeprazole. Disproportionality analysis revealed necitumumab as the drug with the strongest signal, followed by capreomycin, panitumumab, pantoprazole, and omeprazole. Among the top 50 drugs from the disproportionality analysis, 31 signal drugs had labels that did not mention the risk of hypomagnesemia. We issue warnings regarding drugs associated with specific combination therapies that cause adverse reactions leading to hypomagnesemia. Furthermore, to delve deeper into the relationship between drugs and hypomagnesemia, reliance on more credible research in this field is required.

The role of magnesium supplementation in reducing the risk of gestational diabetes (GD) has not been elucidated. To evaluate the effect of magnesium chloride (MgCl2) on the risk of developing GD in a model of obese rats with hydrochlorothiazide-induced hypomagnesemia. Female Wistar rats were allocated into a healthy control or obese group. Obesity was induced with an obesogenic diet and defined by a body weight 30% higher than that of the healthy control group. Once obesity was induced and before pregnancy, hypomagnesemia was generated using hydrochlorothiazide (5 mg/kg body weight). Subsequently, the oestrous cycle was evaluated to proceed for mating. Once pregnancy was confirmed, the obese rats were allocated to an intervention group (IG) or control group (HOCG). Rats in the IG received MgCl2 (50 mg/kg body weight, equivalent to 500 mg per day in humans). Fasting glucose and ionized magnesium levels were determined on days 6, 15, and 20 of pregnancy. An oral glucose tolerance test was performed on day 15 of pregnancy. Rats in the IG had significantly increased ionized magnesium (p=0.009), decreased fasting (p=0.02) and two-hour post-load (p=0.04) glucose levels, and exhibited lower body weight gain than the HOCG (p<0.05). At the end of the study, 75% of the rats in the HOCG, but none in the IG, fulfilled the diagnostic criteria for GD. In obese hypomagnesaemic rats, magnesium supplementation, using MgCl2, reduces fasting and two-hour post-load glucose levels as well as the risk of developing GD, and induces lower body weight gain during pregnancy.

Total serum magnesium concentration is rarely determined in clinical practice. Moreover, there is currently no standardised and evidence-based reference range for serum magnesium. The aim of this communication is to propose a reference range that is evidence-based and reflects the preventive potential of optimal magnesium levels. A literature search was conducted in the PubMed database using the terms "serum magnesium", "reference interval", "reference range", and "hypomagnesemia". Additionally, citations from relevant studies were consulted. There is considerable variation between laboratories with regards to the lower limit of magnesium in serum. The majority of limits are considerably below the 0.85 mmol/L (2.07 mg/dL) threshold proposed by expert groups. The rationale for this limit is that lower levels are associated with an increased risk of diseases such as type 2 diabetes and cardiovascular diseases. To prevent health risks associated with low magnesium levels, the lower limit of serum magnesium should be raised to 0.85 mmol/L and standardised between laboratories. At least, laboratory reports should note that levels below 0.85 mmol/L are associated with an increased risk of disease. Furthermore, the determination of serum magnesium should be afforded the same importance in routine laboratory diagnostics as the determination of other electrolytes.

Hypomagnesemia is significantly more frequent in acute pancreatitis (AP) patients. Magnesium sulfate is a routine drug used in clinical practice to treat hypomagnesemia. This study aimed to explore the association between magnesium sulfate administration and short-term mortality among intensive care unit (ICU)-admitted AP patients. Data of this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) and MIMIC-IV database. The exposure was magnesium sulfate administration during the ICU stay. The primary outcome was 30-day mortality. The secondary outcome was in-hospital mortality. The weighted univariate and multivariate cox proportional hazard models were utilized to explore the association between magnesium sulfate administration and 30-day mortality and in-hospital mortality among ICU-admitted AP patients, based on hazard ratios (HRs) and 95% confidence interval (CIs). Subgroup analyses were conducted based on different age, gender, scoring systems and complications. A total of 1,924 AP patients were included. Of these, 1,334 (69.33%) received magnesium sulfate administration. After adjustment for all covariates, magnesium sulfate administration was associated with a lower risk of 30-day mortality (HR=0.49, 95%CI: 0.36-0.66) and in-hospital mortality (HR=0.42, 95% CI: 0.31-0.57) among ICU-admitted AP patients. This association remained robust when subgroup analyses were conducted based on age, gender, history of hypomagnesemia, heart failure, hypertension, diabetes, liver disease, acute kidney injury and sepsis, and Bedside Index of Severity of Acute Pancreatitis (BISAP) and Charlson Comorbidity Index (CCI). The administration of magnesium sulfate may have potential benefits in improving the short-term prognosis of ICU-admitted AP patients.

Orthopaedic implant-related infections (IRIs) are severe postoperative complications that are difficult to clear by debridement or antibiotic treatments. Magnesium oxide (MgO) effectively inhibits or kills a broad spectrum of bacteria, is minimally associated with safety issues, and poses no risk of inducing antibiotic resistance. Therefore, MgO has been actively studied for environmental, hygienic, as well as clinical applications such as the management of IRIs. This narrative review discusses the antibacterial properties of MgO, related mechanisms, and recent studies related to orthopaedic IRIs. Existing problems and potential possibilities for further research are also suggested.