Hypomagnesemia: a multifactorial complication of treatment of patients with severe burn trauma

Hypomagnesemia is reportedly a common complication of care during the early period of recovery from major trauma. Aminoglycoside treatment, by provoking inappropriate renal magnesium wasting, may contribute to the frequency of hypomagnesemia. We examined the magnesium (Mg) status of six severely burned adolescents during the early phase of recovery. Although provision of Mg met recommended levels, hypomagnesemia occurred in every patient. Two of five of our patients were hypomagnesemic during gentamycin treatment, and five of five during subsequent tobramycin therapy (including the three not affected by gentamycin). Additional episodes occurred in five patients in the absence of aminoglycosides. An interrelationship between Mg status and efficacy of potassium repletion is detailed for one patient. Hypomagnesemia during tobramycin treatment was associated with refractoriness to potassium repletion. Recurrence of hypokalemia during a subsequent diuresis-induced hypomagnesemia was prevented by Mg supplementation. The Mg requirement is increased during recovery from severe burns and appears to exceed that provided by commercially available enteral formulations.