The Laboratory and Clinical Perspectives of Magnesium Imbalance Original paper

What was reviewed?

This narrative review explained magnesium imbalance from two angles clinicians deal with every day: what magnesium does in the body and how lab testing can mislead interpretation. The authors emphasized that magnesium is mainly intracellular and acts as a calcium antagonist, so small shifts can affect neuromuscular function and cardiac conduction. They framed magnesium as a “forgotten analyte” that often hides behind other electrolyte problems, especially potassium, calcium, and phosphate changes, and they focused on how to interpret results in real clinical settings.

Who was reviewed?

The paper did not enroll patients because it was not a clinical trial; it reviewed prior publications across general populations and hospitalized settings. It drew heavily from evidence relevant to inpatients and ICU care, where hypomagnesemia is common and outcomes worsen when magnesium, potassium, and calcium abnormalities occur together. It also reviewed evidence tied to risk groups with impaired intake, absorption, or losses, including people with inflammatory bowel disease, short bowel states, bariatric surgery, alcoholism, diuretic exposure, and proton pump inhibitor use, along with those with kidney disease who are prone to hypermagnesemia.

What were the most important findings?

The review showed that magnesium interpretation fails when clinicians rely on one number without context. Serum magnesium reflects only a tiny extracellular fraction and can miss intracellular depletion, so “normal” values do not always rule out clinically relevant deficiency, especially when refractory hypokalemia or unexplained hypocalcemia appears. It also detailed common lab pitfalls that create false results, including hemolysis causing pseudo-hypermagnesemia and anticoagulants or collection issues altering free magnesium measurements.

What are the greatest implications of this review?

Clinicians should treat magnesium as a driver of multi-electrolyte instability, not as an optional add-on test. When potassium and calcium disorders persist despite replacement, magnesium deficiency should move to the top of the differential, and workup should consider urinary measures or loading approaches when deficiency is suspected but serum values look reassuring. From a microbiome-informed care lens, the strongest clinical bridge is practical: gut disease and gut function change magnesium handling, so persistent dysbiosis symptoms, diarrhea, malabsorption, or motility impairment can meaningfully alter magnesium status and downstream neuromuscular and cardiac risk.