Effects of magnesium infusions on magnesium and nitrogen balance during parenteral nutrition

The effects of magnesium infusions on urinary and fecal magnesium excretion, serum magnesium and nitrogen balance were examined in seven well-nourished and three nutritionally depleted adult surgical patients receiving total parenteral nutrition. They were maintained on constant nitrogen and caloric intake for 14 +/- 2 days. Magnesium doses ranged from 0 to 664 mg/d and were given in varying crossover patterns. In both groups, urinary magnesium excretion increased as the amount of magnesium infused increased but, at comparable magnesium infusions, depleted patients excreted significantly less magnesium. Renal conservation was most pronounced in well-nourished patients on magnesium-free intake and in depleted patients given 70 mg magnesium daily. Urinary magnesium losses were 40 +/- 5 mg/d and 33 +/- 8 mg/d, respectively, in these two groups. Endogenous fecal magnesium excretion was minimal and ranged from 2 to 38 mg/d. At each level of magnesium intake, serum levels of well-nourished patients were normal. With infusions of less than 200 mg/d, serum magnesium concentrations in depleted subjects averaged 1.6 mg/dl. Reduced urinary magnesium excretion as well as borderline serum levels measured in depleted adults suggest that the magnesium dosage should be higher than that usually recommended during total parenteral nutrition. In both groups a positive correlation between magnesium and nitrogen balance was noted.