What are the recommended management strategies for mild to moderate hypomagnesaemia in a primary care setting?

Management strategies for mild to moderate hypomagnesaemia in primary care include:

• Identify and address underlying causes such as gastrointestinal losses (vomiting, diarrhoea), medication effects, or nutritional deficiencies.

• Oral magnesium supplementation is recommended as the first-line treatment for mild to moderate hypomagnesaemia, unless there are issues with gastrointestinal absorption or the electrolyte disturbance is severe, in which case specialist referral or parenteral supplementation may be needed.

• Monitor electrolyte levels and clinical symptoms regularly to assess response to treatment and detect any complications.

• In patients with risk factors such as eating disorders involving purging or laxative/diuretic misuse, provide additional support and monitoring, including ECG if indicated, due to risk of cardiac arrhythmias.

• Advise patients on dietary sources of magnesium and encourage adequate nutritional intake.

Referral to secondary care should be considered if hypomagnesaemia is severe, persistent despite oral supplementation, or associated with significant clinical symptoms or complications.

This approach aligns with NICE guidance on electrolyte management in eating disorders and general principles of managing mild to moderate electrolyte imbalances in primary care settings NICE NG69.