Enteral When Compared With IV Magnesium Replacement in the Critically Ill: A Noninferiority Randomized Clinical Trial
Primary resultResult — go to the resultMean difference −0.12 mmol/L 95% CI −0.16 to −0.07Authors' conclusion
Enteral magnesium replacement for mild-to-moderate hypomagnesemia did not establish noninferiority to IV replacement at a margin of 0.1 mmol/L but it reduced urinary concentration of magnesium, cost, environmental waste, carbon emissions, and IV fluid administration.
Study context
- Population
- ICU patients (mixed medical-surgical-trauma) with serum magnesium 0.35–0.7 mmol/LJune 2023–May 2024
- Participants
- 360 patients
- Comparison
- Enteral vs IV magnesium replacement
- Primary endpoint
- Serum magnesium concentration (noninferiority margin 0.1 mmol/L)
- Follow-up
- 24 hours after enrollment
Methodological detailsnoninferiority, prospective, open-label, parallel-group, electronic medical record-embedded, single-centre
- Noninferiority
- Prospective
- Open-label
- Parallel-group
- Electronic medical record-embedded
- Single-centre
Primary result
As reported in the abstract
24 hours
Mean difference
−0.12 mmol/L
95% CI −0.16 to −0.07
By group
Enteral vs IV
mean difference −0.12 mmol/L (95% CI −0.16 to −0.07)
Secondary outcomes
| Outcome | Median difference (Australian dollars) (95% CI) | |
|---|---|---|
| Cost | −6.48 (−7.40 to −5.56) | |
| −10−505Difference, Australian dollars (linear scale) |
| Outcome | Median difference (grams) (95% CI) | |
|---|---|---|
| Waste | −55 (−58 to −51) | |
| CO2 footprint | −946 (−996 to −896) | |
| −1000−5000500Difference, grams (linear scale) |
| Outcome | Estimate |
|---|---|
| Urine magnesium (AUC) | median difference −46.2 mmol·hr/L |
| Additional IV fluid administrationIQR −200 to −100 mL | median −100 mL |
Other outcomes (magnesium dose, bloodstream infections, new AF, duration of admission, mortality)
- No between group differences
Original publication
Enteral When Compared With IV Magnesium Replacement in the Critically Ill: A Noninferiority Randomized Clinical Trial. Crit Care Med. Published 1 June 2026. doi:10.
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