Causes of Magnesium Wasting

by Herbert C. Mansmann Jr., M.D.*, and Shawna Kopchu RN**

Many people already know that when you take diuretics (Water Pills) you need to take a potassium supplement since potassium is lost through the urine. This is also true for Mg. There are certain medications and lifestyle behaviors that can cause excessive Mg loss in the urine. If you are on any of these medications or display any of the lifestyle behaviors you will need to take a Mg supplement to accommodate the loss and prevent hypomagnesemia. There are also specific diseases that can cause Mg loss in the urine and are listed below.


  • Aminoglycoside Antibiotics
    • amikacin sulfate (Amikin)
    • gentamicin sulfate (Cidomicin, Garamycin, Gentamicin sulfate, ADD-Vantage, Jenamicin)
    • neomycin sulfate (Mycifradin, Neo-fradin, Neosulf, Neo-Tabs)
      streptomycin sulfate
    • tobramycin sulfate (Nebcin)
  • Cisplantin (Platamine, Platinol, Platinol AQ)
  • Pentamidine isethionate (NebuPent, Pentacarinat, Pentam 300, Pneumopent)
  • Foscarnet sodium (Foscavir)
  • Diuretics
    • Furosemide (Lasix, Apo-Furosemide, Myrosemide, NovoSemide, Urex, Urex-M, Uritol)
    • Butmetanide (Bumex, Burinex)
    • Chlorthalidone (Apo-Chlorthalidone, Hygroton, Novo-Thalidone, Thalitone, Uridon)
    • ethacrynate sodium (Sodium Edecrin)
    • hydrochlorothiazide (Apo-Hydro, Aquazide-H, Dichlotride, Diuchlor H, Esidrix, Ezide, Hydro-D, Dydro-Diuril, Mictrin, Codema, Novo-Hydrazide, Oretic, Urozide)
    • indapamide (Lozide, Lozol, Natrilix)
    • metolazone (Diulo, Mykrox, Zaroxolyn)
    • torsemide (Demadex)
    • urea carbamide (Ureaphil)
    • acetazolamide (Diamox, Acetazolam, Dazamide, AK-Zol)
    • mannitol (Osmitrol)
  • Macrolide Anti-Infectives
    • azithromycin (Zithromax)
    • clarithromycin (Biaxin)
    • dirithromycin (Dynabac)
    • erythromycin (E-Mycin, Erybid, EES, Erythrocin)
  • tacrolimus (Prograf)
  • Cyclosporine (Neoral, Sandimmun, Sandimmune)
  • Potassium phosphate
  • Calcium Supplements
  • Vitamin D Supplements

Other Causes

  • Diabetic Ketoacidosis
  • Hyperaldosteronism
  • Hyperglycemia
  • Refeeding after starvation
  • Alcohol (Acute ingestion and/or due to transitory hypoparathyroidism
  • Hyperparathyroidism
  • Glomerulonephritis
  • Pyelonephritis
  • Renal Tubular Acidosis
  • Bartters syndrome
  • Gitelmans syndrome
  • Cirrhosis
  • Pancreatitis
  • Burn Patients
  • Patients receiving sodium rich IV fluids
  • Thyrotoxicosis
  • Citrate preservative in blood products
  • Congenital Magnesium Losing Nephropathy
  • Urea Osmotic Diuresis


1. Kelley, W.N., Ed. Textbook of Internal Medicine, 3rd Edition, 1996, Lippincott-Raven, Philadelphia
2. Hardman, J.G., Limbird, L.E., Goodman & Gilmans The Pharmacological Basis of Therapeutics, 9th edition, McGraw-Hill Co, New York
3. Medley, Norma, Fluid and Electrolyte Balance Nursing Considerations, J.B. Lippincott Co, Philadelphia
4. Mauskop, Alexander, The Headache Alternative A Neurologist’s Guide to Drug-Free Relief, Dell Publishing 1997.
5. Nursing 99 Drug Handbook, Springhouse Corporation, Springhouse PA
6. Herbert C. Mansmann Jr., MD, Professor of Medicine at Thomas Jefferson University and Director of Magnesium Research Laboratory, Philadelphia, PA

*Professor of pediatrics, Associate Professor of Medicine, and Director of The Magnesium Research Laboratory, at Jefferson Medical College, of Thomas Jefferson University, Philadelphia, PA.

**Registered Nurse and Original Director

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