Overview: Renal Insufficiency:
Magnesium is excreted solely by the kidney.
In patients with severe renal insufficiency (e.g. < 30 ml/min), the dose
should be lower and frequent serum magnesium levels must be obtained
Caution should be used when replacing magnesium in any patient with
renal insufficiency.
Magnesium balance is primarily a kidney function (magnesium intake does
not appear to be regulated). The average diet provides 20 - 30 mEq
daily, but the net absorption is only about 7 mEq. The kidneys normally
excrete an equal amount in order to maintain the magnesium balance.
However, in the presence of magnesium deficiency urinary magnesium
excretion can be reduced to a minimum of about 2 mEq/day. Renal
magnesium reabsorption takes place primarily in the proximal
tubule (30% of the filtered load) and the thick ascending limb of
Henle's loop (65%). Overall renal reabsorption appears to be saturable,
so that a higher magnesium intake results in a proportional increase in
urinary excretion. For this reason, it is difficult for patients with
normal renal function to develop hypermagnesemia.
Hemodialysis
See comments above.
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