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. 1985 Feb 15;132(4):360–368.

A clinical approach to common electrolyte problems: 4. Hypomagnesemia.

C Berkelhammer, R A Bear
PMCID: PMC1345822  PMID: 3918779

Abstract

Magnesium plays a critical role in many cell functions. Hypomagnesemia may occur because of decreased intake or absorption, internal redistribution or increased loss of this element through either renal or nonrenal routes. Manifestations of magnesium deficiency include alterations in calcium, phosphate and potassium homeostasis along with cardiac disorders such as malignant ventricular arrhythmias refractory to conventional therapy, enhanced sensitivity to digoxin and, possibly, coronary artery vasospasm and sudden death. Other features of magnesium deficiency include a host of neuromuscular and neuropsychiatric disorders. In this review we detail mechanisms that may lead to magnesium deficiency, summarize the clinical features of the deficiency and provide a clinical approach to the diagnosis and treatment of this electrolyte disorder.

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Selected References

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  1. Altura B. M., Altura B. T., Carella A. Magnesium deficiency-induced spasms of umbilical vessels: relation to preeclampsia, hypertension, growth retardation. Science. 1983 Jul 22;221(4608):376–378. doi: 10.1126/science.6867714. [DOI] [PubMed] [Google Scholar]
  2. Altura B. M., Altura B. T., Gebrewold A., Ising H., Günther T. Magnesium deficiency and hypertension: correlation between magnesium-deficient diets and microcirculatory changes in situ. Science. 1984 Mar 23;223(4642):1315–1317. doi: 10.1126/science.6701524. [DOI] [PubMed] [Google Scholar]
  3. Altura B. M., Altura B. T. Magnesium ions and contraction of vascular smooth muscles: relationship to some vascular diseases. Fed Proc. 1981 Oct;40(12):2672–2679. [PubMed] [Google Scholar]
  4. Anderson T. W., Neri L. C., Schreiber G. B., Talbot F. D., Zdrojewski A. Letter: Ischemic heart disease, water hardness and myocardial magnesium. Can Med Assoc J. 1975 Aug 9;113(3):199–203. [PMC free article] [PubMed] [Google Scholar]
  5. Avioli L. V., Berman M. Mg28 kinetics in man. J Appl Physiol. 1966 Nov;21(6):1688–1694. doi: 10.1152/jappl.1966.21.6.1688. [DOI] [PubMed] [Google Scholar]
  6. BOOTH C. C., BABOURIS N., HANNA S., MACINTYRE I. Incidence of hypomagnesaemia in intestinal malabsorption. Br Med J. 1963 Jul 20;2(5350):141–144. doi: 10.1136/bmj.2.5350.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bar R. S., Wilson H. E., Mazzaferri E. L. Hypomagnesemic hypocalcemia secondary to renal magnesium wasting. Ann Intern Med. 1975 May;82(5):646–649. doi: 10.7326/0003-4819-82-5-646. [DOI] [PubMed] [Google Scholar]
  8. Broitman S. A., McCray R. S., May J. C., Deren J. J., Ackroyd F., Gottlieb L. S., McDermott W., Zamcheck N. Mastocytosis and intestinal malabsorption. Am J Med. 1970 Mar;48(3):382–389. doi: 10.1016/0002-9343(70)90069-0. [DOI] [PubMed] [Google Scholar]
  9. Burch G. E., Giles T. D. The importance of magnesium deficiency in cardiovascular disease. Am Heart J. 1977 Nov;94(5):649–657. doi: 10.1016/s0002-8703(77)80137-3. [DOI] [PubMed] [Google Scholar]
  10. Burgess J. L., Birchall R. Nephrotoxicity of amphotericin B, with emphasis on changes in tubular function. Am J Med. 1972 Jul;53(1):77–84. [PubMed] [Google Scholar]
  11. Bøhmer T., Mathiesen B. Magnesium deficiency in chronic alcoholic patients uncovered by an intravenous loading test. Scand J Clin Lab Invest. 1982 Dec;42(8):633–636. [PubMed] [Google Scholar]
  12. Caddell J. L., Goddard D. R. Studies in protein-calorie malnutriton. I. Chemical evidence for magnesium deficiency. N Engl J Med. 1967 Mar 9;276(10):533–535. doi: 10.1056/NEJM196703092761001. [DOI] [PubMed] [Google Scholar]
  13. Cohen M. I., McNamara H., Finberg L. Serum magnesium in children with cirrhosis. J Pediatr. 1970 Mar;76(3):453–455. doi: 10.1016/s0022-3476(70)80489-9. [DOI] [PubMed] [Google Scholar]
  14. Cronin R. E., Knochel J. P. Magnesium deficiency. Adv Intern Med. 1983;28:509–533. [PubMed] [Google Scholar]
  15. Davis B. B., Preuss H. G., Murdaugh H. V., Jr Hypomagnesemia following the diuresis of post-renal obstruction and renal transplant. Nephron. 1975;14(3-4):275–280. doi: 10.1159/000180457. [DOI] [PubMed] [Google Scholar]
  16. Dhingra S., Solven F., Wilson A., McCarthy D. S. Hypomagnesemia and respiratory muscle power. Am Rev Respir Dis. 1984 Mar;129(3):497–498. doi: 10.1164/arrd.1984.129.3.497. [DOI] [PubMed] [Google Scholar]
  17. Dirks J. H. The kidney and magnesium regulation. Kidney Int. 1983 May;23(5):771–777. doi: 10.1038/ki.1983.93. [DOI] [PubMed] [Google Scholar]
  18. Drenick E. J., Hunt I. F., Swendseid M. E. Magnesium depletion during prolonged fasting of obese males. J Clin Endocrinol Metab. 1969 Oct;29(10):1341–1348. doi: 10.1210/jcem-29-10-1341. [DOI] [PubMed] [Google Scholar]
  19. Dyckner T., Wester P. O. Effect of magnesium on blood pressure. Br Med J (Clin Res Ed) 1983 Jun 11;286(6381):1847–1849. doi: 10.1136/bmj.286.6381.1847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Elin R. J., Alling D. W. Survival of normal and magnesium-deficient erythrocytes in rats: effect of magnesium-deficient diet vs. splenectomy. J Lab Clin Med. 1978 Apr;91(4):666–672. [PubMed] [Google Scholar]
  21. Evans R. A., Carter J. N., George C. R., Walls R. S., Newland R. C., McDonnell G. D., Lawrence J. R. The congenital "magnesium-losing kidney". Report of two patients. Q J Med. 1981;50(197):39–52. [PubMed] [Google Scholar]
  22. FLETCHER R. F., HENLY A. A., SAMMONS H. G., SQUIRE J. R. A case of magnesium deficiency following massive intestinal resection. Lancet. 1960 Mar 5;1(7123):522–525. doi: 10.1016/s0140-6736(60)90453-0. [DOI] [PubMed] [Google Scholar]
  23. Flink E. B. Nutritional aspects of magnesium metabolism. West J Med. 1980 Oct;133(4):304–312. [PMC free article] [PubMed] [Google Scholar]
  24. Flink E. B., Shane S. R., Scobbo R. R., Blehschmidt N. G., McDowell P. Relationship of free fatty acids and magnesium in ethanol withdrawal in dogs. Metabolism. 1979 Aug;28(8):858–865. doi: 10.1016/0026-0495(79)90213-0. [DOI] [PubMed] [Google Scholar]
  25. Freeman J. B., Wittine M. F., Stegink L. D., Mason E. D. Effects of magnesium infusions on magnesium and nitrogen balance during parenteral nutrition. Can J Surg. 1982 Sep;25(5):570-2, 574. [PubMed] [Google Scholar]
  26. GERST P. H., PORTER M. R., FISHMAN R. A. SYMPTOMATIC MAGNESIUM DEFICIENCY IN SURGICAL PATIENTS. Ann Surg. 1964 Mar;159:402–406. doi: 10.1097/00000658-196403000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. GOLDMAN A. S., VAN FOSSAN D. D., BAIRD E. E. Magnesium deficiency in celiac disease. Pediatrics. 1962 Jun;29:948–952. [PubMed] [Google Scholar]
  28. GREENWALD J. H., DUBIN A., CARDON L. HYPOMAGNESEMIC TETANY DUE TO EXCESSIVE LACTATION. Am J Med. 1963 Dec;35:854–860. doi: 10.1016/0002-9343(63)90247-x. [DOI] [PubMed] [Google Scholar]
  29. George P., André C. Is there a role for routine estimations of plasma magnesium? Clin Biochem. 1983 Jun;16(3):191–194. doi: 10.1016/s0009-9120(83)90267-9. [DOI] [PubMed] [Google Scholar]
  30. Goldman R. H., Kleiger R. E., Schweizer E., Harrison D. C. The effect of myocardial 3H-digoxin of magnesium deficiency. Proc Soc Exp Biol Med. 1971 Mar;136(3):747–749. doi: 10.3181/00379727-136-35356. [DOI] [PubMed] [Google Scholar]
  31. HORTON R., BIGLIERI E. G. Effect of aldosterone on the metabolism of magnesium. J Clin Endocrinol Metab. 1962 Dec;22:1187–1192. doi: 10.1210/jcem-22-12-1187. [DOI] [PubMed] [Google Scholar]
  32. Hamed I. A., Lindeman R. D. Dysphagia and vertical nystagmus in magnesium deficiency. Ann Intern Med. 1978 Aug;89(2):222–223. doi: 10.7326/0003-4819-89-2-222. [DOI] [PubMed] [Google Scholar]
  33. Hersh T., Siddiqui D. A. Magnesium and the pancreas. Am J Clin Nutr. 1973 Mar;26(3):362–366. doi: 10.1093/ajcn/26.3.362. [DOI] [PubMed] [Google Scholar]
  34. Hocking M. P., Duerson M. C., O'Leary J. P., Woodward E. R. Jejunoileal bypass for morbid obesity. Late follow-up in 100 cases. N Engl J Med. 1983 Apr 28;308(17):995–999. doi: 10.1056/NEJM198304283081703. [DOI] [PubMed] [Google Scholar]
  35. Iseri L. T., Chung P., Tobis J. Magnesium therapy for intractable ventricular tachyarrhythmias in normomagnesemic patients. West J Med. 1983 Jun;138(6):823–828. [PMC free article] [PubMed] [Google Scholar]
  36. Iseri L. T., Freed J., Bures A. R. Magnesium deficiency and cardiac disorders. Am J Med. 1975 Jun;58(6):837–846. doi: 10.1016/0002-9343(75)90640-3. [DOI] [PubMed] [Google Scholar]
  37. Isner J. M., Sours H. E., Paris A. L., Ferrans V. J., Roberts W. C. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979 Dec;60(6):1401–1412. doi: 10.1161/01.cir.60.6.1401. [DOI] [PubMed] [Google Scholar]
  38. Johansson G. Magnesium and renal stone disease. Acta Med Scand Suppl. 1982;661:13–18. doi: 10.1111/j.0954-6820.1982.tb00386.x. [DOI] [PubMed] [Google Scholar]
  39. Johnson C. J., Peterson D. R., Smith E. K. Myocardial tissue concentrations of magnesium and potassium in men dying suddenly from ischemic heart disease. Am J Clin Nutr. 1979 May;32(5):967–970. doi: 10.1093/ajcn/32.5.967. [DOI] [PubMed] [Google Scholar]
  40. KALBFLEISCH J. M., LINDEMAN R. D., GINN H. E., SMITH W. O. EFFECTS OF ETHANOL ADMINISTRATION ON URINARY EXCRETION OF MAGNESIUM AND OTHER ELECTROLYTES IN ALCOHOLIC AND NORMAL SUBJECTS. J Clin Invest. 1963 Sep;42:1471–1475. doi: 10.1172/JCI104831. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. KELLAWAY G., EWEN K. Magnesium deficiency complicating prolonged gastric suction. N Z Med J. 1962 Mar;61:137–142. [PubMed] [Google Scholar]
  42. Kobayashi A., Utsunomiya T., Obe Y., Nagashima Y. Intestinal absorption of calcium and magnesium in hepatobiliary disease in infancy. Arch Dis Child. 1974 Feb;49(2):90–96. doi: 10.1136/adc.49.2.90. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. LINDER G. C., HANSEN J. D., KARABUS C. D. The metabolism of magnesium and other inorganic cations and of nitrogen in acute kwashiorkor. Pediatrics. 1963 Apr;31:552–568. [PubMed] [Google Scholar]
  44. Licata A. A., Lantigua R., Amatruda J., Lockwood D. Adverse effects of liquid protein fast on the handling of magnesium, calcium and phosphorus. Am J Med. 1981 Nov;71(5):767–772. doi: 10.1016/0002-9343(81)90362-4. [DOI] [PubMed] [Google Scholar]
  45. Lim P., Jacob E. Magnesium status of alcoholic patients. Metabolism. 1972 Nov;21(11):1045–1051. doi: 10.1016/0026-0495(72)90035-2. [DOI] [PubMed] [Google Scholar]
  46. Lim P., Jacob E. Tissue magnesium level in chronic diarrhea. J Lab Clin Med. 1972 Sep;80(3):313–321. [PubMed] [Google Scholar]
  47. Lipner A. Symptomatic magnesium deficiency after small-intestinal bypass for obesity. Br Med J. 1977 Jan 15;1(6054):148–148. doi: 10.1136/bmj.1.6054.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Lyman N. W., Hemalatha C., Viscuso R. L., Jacobs M. G. Cisplatin-induced hypocalcemia and hypomagnesemia. Arch Intern Med. 1980 Nov;140(11):1513–1514. [PubMed] [Google Scholar]
  49. MACINTYRE I., HANNA S., BOOTH C. C., READ A. E. Intracellular magnesium deficiency in man. Clin Sci. 1961 Jun;20:297–305. [PubMed] [Google Scholar]
  50. MARTIN H. E., SMITH K., WILSON M. L. The fluid and electrolyte therapy of severe diabetic acidosis and ketosis; a study of twenty-nine episodes (twenty-six patients). Am J Med. 1958 Mar;24(3):376–389. doi: 10.1016/0002-9343(58)90324-3. [DOI] [PubMed] [Google Scholar]
  51. METCOFF J., FRENK S., ANTONOWICZ I., GORDILLO G., LOPEZ E. Relations of intracellular ions to metabolite sequences in muscle in kwashirkor. A new reference for assessing the significance of intracellular concentrations of ions. Pediatrics. 1960 Dec;26:960–972. [PubMed] [Google Scholar]
  52. Macaulay V. M., Begent R. H., Phillips M. E., Newlands E. S. Prophylaxis against hypomagnesaemia induced by cis-platinum combination chemotherapy. Cancer Chemother Pharmacol. 1982;9(3):179–181. doi: 10.1007/BF00257749. [DOI] [PubMed] [Google Scholar]
  53. Mace J. W., Hambidge K. M., Gotlin R. W., Dubois R. S., Solomons C. S., Katz F. H. Magnesium supplementation in Bartter's syndrome. Arch Dis Child. 1973 Jun;48(6):485–487. doi: 10.1136/adc.48.6.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Marks P., Ashraf H. Apathetic hyperthyroidism with hypomagnesaemia and raised alkaline phosphatase concentration. Br Med J. 1978 Apr 1;1(6116):821–822. doi: 10.1136/bmj.1.6116.821. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Martin H. E. Clinical magnesium deficiency. Ann N Y Acad Sci. 1969 Aug 15;162(2):891–900. doi: 10.1111/j.1749-6632.1969.tb13018.x. [DOI] [PubMed] [Google Scholar]
  56. Massry S. G. Pharmacology of magnesium. Annu Rev Pharmacol Toxicol. 1977;17:67–82. doi: 10.1146/annurev.pa.17.040177.000435. [DOI] [PubMed] [Google Scholar]
  57. McCarron D. A. Calcium and magnesium nutrition in human hypertension. Ann Intern Med. 1983 May;98(5 Pt 2):800–805. doi: 10.7326/0003-4819-98-5-800. [DOI] [PubMed] [Google Scholar]
  58. McLellan B. A., Reid S. R., Lane P. L. Massive blood transfusion causing hypomagnesemia. Crit Care Med. 1984 Feb;12(2):146–147. doi: 10.1097/00003246-198402000-00014. [DOI] [PubMed] [Google Scholar]
  59. McMullen J. K. Asystole and hypomagnesaemia during recovery from diabetic ketoacidosis. Br Med J. 1977 Mar 12;1(6062):690–690. doi: 10.1136/bmj.1.6062.690. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Mendelson J. H., Ogata M., Mello N. K. Effects of alcohol ingestion and withdrawal on magnesium states of alcoholics: clinical and experimental findings. Ann N Y Acad Sci. 1969 Aug 15;162(2):918–933. doi: 10.1111/j.1749-6632.1969.tb13021.x. [DOI] [PubMed] [Google Scholar]
  61. Mennes P., Rosenbaum R., Martin K., Slatopolsky E. Hypomagnesemia and impaired parathyroid hormone secretion in chronic renal disease. Ann Intern Med. 1978 Feb;88(2):206–209. doi: 10.7326/0003-4819-88-2-206. [DOI] [PubMed] [Google Scholar]
  62. NIELSEN B., THORN N. A. TRANSIENT EXCESS URINARY EXCRETION OF ANTIDIURETIC MATERIAL IN ACUTE INTERMITTENT PORPHYRIA WITH HYPONATREMIA AND HYPOMAGNESEMIA. Am J Med. 1965 Mar;38:345–358. doi: 10.1016/0002-9343(65)90144-0. [DOI] [PubMed] [Google Scholar]
  63. Narins R. G., Jones E. R., Stom M. C., Rudnick M. R., Bastl C. P. Diagnostic strategies in disorders of fluid, electrolyte and acid-base homeostasis. Am J Med. 1982 Mar;72(3):496–520. doi: 10.1016/0002-9343(82)90521-6. [DOI] [PubMed] [Google Scholar]
  64. Nichols B. L., Alvarado J., Hazlewood C. F., Viteri F. Magnesium supplementation in protein-calorie malnutrition. Am J Clin Nutr. 1978 Jan;31(1):176–188. doi: 10.1093/ajcn/31.1.176. [DOI] [PubMed] [Google Scholar]
  65. OPIE L. H., HUNT B. G., FINLAY J. M. MASSIVE SMALL BOWEL RESECTION WITH MALABSORPTION AND NEGATIVE MAGNESIUM BALANCE. Gastroenterology. 1964 Oct;47:415–420. [PubMed] [Google Scholar]
  66. Orenstein S. R., Orenstein D. M. Magnesium deficiency in cystic fibrosis. South Med J. 1983 Dec;76(12):1586–1586. doi: 10.1097/00007611-198312000-00037. [DOI] [PubMed] [Google Scholar]
  67. Parfitt A. M., Miller M. J., Frame B., Villanueva A. R., Rao D. S., Oliver I., Thomson D. L. Metabolic bone disease after intestinal bypass for treatment of obesity. Ann Intern Med. 1978 Aug;89(2):193–199. doi: 10.7326/0003-4819-89-2-193. [DOI] [PubMed] [Google Scholar]
  68. Parsons F. M., Edwards G. F., Anderson C. K., Ahmad S., Clark P. B., Hetherington C., Young G. A. Regression of malignant tumours in magnesium and potassium depletion induced by diet and haemodialysis. Lancet. 1974 Feb 16;1(7851):243–244. doi: 10.1016/s0140-6736(74)92549-5. [DOI] [PubMed] [Google Scholar]
  69. Paunier L., Radde I. C., Kooh S. W., Conen P. E., Fraser D. Primary hypomagnesemia with secondary hypocalcemia in an infant. Pediatrics. 1968 Feb;41(2):385–402. [PubMed] [Google Scholar]
  70. Quamme G. A., Dirks J. H. Renal magnesium transport. Rev Physiol Biochem Pharmacol. 1983;97:69–110. doi: 10.1007/BFb0035346. [DOI] [PubMed] [Google Scholar]
  71. Randall R. E., Jr Magnesium metabolism in chronic renal disease. Ann N Y Acad Sci. 1969 Aug 15;162(2):831–846. doi: 10.1111/j.1749-6632.1969.tb13013.x. [DOI] [PubMed] [Google Scholar]
  72. Resnick L. M., Laragh J. H., Sealey J. E., Alderman M. H. Divalent cations in essential hypertension. Relations between serum ionized calcium, magnesium, and plasma renin activity. N Engl J Med. 1983 Oct 13;309(15):888–891. doi: 10.1056/NEJM198310133091504. [DOI] [PubMed] [Google Scholar]
  73. Rude R. K. Renal cortical adenylate cyclase: characterization of magnesium activation. Endocrinology. 1983 Oct;113(4):1348–1355. doi: 10.1210/endo-113-4-1348. [DOI] [PubMed] [Google Scholar]
  74. Schilsky R. L., Anderson T. Hypomagnesemia and renal magnesium wasting in patients receiving cisplatin. Ann Intern Med. 1979 Jun;90(6):929–931. doi: 10.7326/0003-4819-90-6-929. [DOI] [PubMed] [Google Scholar]
  75. Schilsky R. L., Barlock A., Ozols R. F. Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep. 1982 Sep;66(9):1767–1769. [PubMed] [Google Scholar]
  76. Seelig J. M., Wei E. P., Kontos H. A., Choi S. C., Becker D. P. Effect of changes in magnesium ion concentration on cat cerebral arterioles. Am J Physiol. 1983 Jul;245(1):H22–H26. doi: 10.1152/ajpheart.1983.245.1.H22. [DOI] [PubMed] [Google Scholar]
  77. Seller R. H., Cangiano J., Kim K. E., Mendelssohn S., Brest A. N., Swartz C. Digitalis toxicity and hypomagnesemia. Am Heart J. 1970 Jan;79(1):57–68. doi: 10.1016/0002-8703(70)90394-7. [DOI] [PubMed] [Google Scholar]
  78. Shils M. E. Experimental human magnesium depletion. Medicine (Baltimore) 1969 Jan;48(1):61–85. doi: 10.1097/00005792-196901000-00003. [DOI] [PubMed] [Google Scholar]
  79. Shils M. E. Magnesium, calcium, and parathyroid hormone interactions. Ann N Y Acad Sci. 1980;355:165–180. doi: 10.1111/j.1749-6632.1980.tb21336.x. [DOI] [PubMed] [Google Scholar]
  80. Sours H. E., Frattali V. P., Brand C. D., Feldman R. A., Forbes A. L., Swanson R. C., Paris A. L. Sudden death associated with very low calorie weight reduction regimens. Am J Clin Nutr. 1981 Apr;34(4):453–461. doi: 10.1093/ajcn/34.4.453. [DOI] [PubMed] [Google Scholar]
  81. Thorén L. Magnesium metabolism. A review of the problems related to surgical practice. Prog Surg. 1971;9:131–156. [PubMed] [Google Scholar]
  82. Topol E. J., Lerman B. B. Hypomagnesemic torsades de pointes. Am J Cardiol. 1983 Dec 1;52(10):1367–1368. doi: 10.1016/0002-9149(83)90611-2. [DOI] [PubMed] [Google Scholar]
  83. Turlapaty P. D., Altura B. M. Magnesium deficiency produces spasms of coronary arteries: relationship to etiology of sudden death ischemic heart disease. Science. 1980 Apr 11;208(4440):198–200. doi: 10.1126/science.7361117. [DOI] [PubMed] [Google Scholar]
  84. Webb S., Schade D. S. Letter: Hypomagnessemia as a cause of persistent hypokalemia. JAMA. 1975 Jul 7;233(1):23–24. doi: 10.1001/jama.233.1.23. [DOI] [PubMed] [Google Scholar]
  85. Zipf W. B., Bacon G. E., Spencer M. L., Kelch R. P., Hopwood N. J., Hawker C. D. Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Diabetes Care. 1979 May-Jun;2(3):265–268. doi: 10.2337/diacare.2.3.265. [DOI] [PubMed] [Google Scholar]

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