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Robert Whang, MD
University of Oklahoma Health Sciences Center Oklahoma City

Kenneth W. Ryder, MD
Wishard Memorial Hospital Indiana University Medical Center Indianapolis

JAMA. 1990;264(19):2502.

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In Reply.—

We thank Drs Gayed, Roberts, and Brett for their interest in our report. Our study was designed to assess the effectiveness of physician-initiated requests vs routine determination in identifying patients with abnormal serum magnesium concentrations. Clinical correlation, although desirable, was beyond the scope of this study. It is important to note that clinical perturbation in serum magnesium can have serious implications in patient management. Refractory hypotension, respiratory arrest, and mental obtundation progressing to coma have been associated with hypermagnesemia. Hypomagnesemia can result in neurological symptoms and serious cardiac arrhythmias. How many hospitalized patients today suffer from the consequences of clinically unrecognized hypermagnesemia and hypomagnesemia remains to be determined.

In our opinion, there is an analogy between serum potassium and magnesium. Most clinicians do not wait for hypokalemia to become symptomatic before treating. To wait until magnesium depletion becomes symptomatic before treating may not be in the best . . . [Full Text PDF of this Article]

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