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September 15, 1978

Thiazide-lnduced Hypomagnesemia

JAMA. 1978;240(12):1241. doi:10.1001/jama.1978.03290120035018

To the Editor.—  A recent issue had an interesting article entitled "Thiazide-Induced Hypokalemia: Association With Acute Myocardial Infarction and Ventricular Fibrillation" (239:43, 1978). I saw nowhere in it references to serum magnesium in such patients or discussions of the importance of it. This has been written about for several years,1,2 but the information does not appear to have had wide dissemination. Burch and Giles3 have recently reviewed this topic, and Flink and associates4-6 have done extensive research and writing on magnesium deficiency and toxicity.Diuretics can cause both hypokalemia and hypomagnesemia, and if hypomagnesemia is present, it is essentially impossible to correct the hypokalemia. As a matter of fact, it is a routine order for the coronary care unit nurses in our hospital to obtain the serum magnesium level of new patients who have been taking diuretics for any appreciable length of time. This applies to patients