title: Increases in intravenous magnesium use among hospitalized patients: an institution cross-sectional experience.
abstract: BACKGROUND
  Among hospitalized patients, indications for the measurement of magnesium levels and treatment of hypomagnesemia with intravenous magnesium are not well defined. Recently, there have been reports of worldwide shortages of intravenous magnesium sulphate.
  
  
  OBJECTIVE
  To examine secular trends in the administration of intravenous magnesium on hospital wards at a tertiary care institution. The secondary objective is to identify factors associated with magnesium use among admitted patients.
  
  
  METHODS
  Retrospective cross-section review of hospitalized patients at a single Canadian tertiary care center. Utilization of non-parental nutrition intravenous magnesium from 2003 to 2013 stratified by hospital ward was examined. In addition, patient level data from select wards (including medical and surgical services) was examined at early and more recent time period (4/2006 versus 4/2013).
  
  
  RESULTS
  Among the 248,329 hospitalized patients, intravenous magnesium use increased by 2.86 fold from 2003 to 2013. Not all wards had an increase whereas some had nearly a 10 fold increase in use. In the sample (n = 769), (adjusting for admission magnesium level, presence of an indication for intravenous magnesium, ward location, comorbidity and demographics) intravenous magnesium administration was higher (25.8 % versus 5.5 %) in 2013 versus 2006 (OR 13.91 (95 % CI, 6.21-31.17, p < 0.001). Despite this increase in intravenous magnesium administration, <3 % of patients were admitted on oral magnesium in 2006 and 2013. For patients receiving intravenous magnesium only a minority were discharged on oral therapy despite low levels.
  
  
  CONCLUSIONS
  This center has witnessed a considerable increase in the use of in-hospital intravenous magnesium over the last 6 years that cannot be explained for by medical indications. The risks and benefits of this therapy deserve further study. If this change in practice is representative of other North American hospitals, it may be responsible for recent drug shortages.
authors.affiliation: Department of Medicine, Dalhousie University, Queen Elizabeth II Health Sciences-VG Site, Room 5082 Dickson Building, 5820 University Avenue, Halifax, Nova Scotia B3H 1V8 Canada.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Kiberd
authors.affiliation: Department of Medicine, Dalhousie University, Queen Elizabeth II Health Sciences-VG Site, Room 5070 Dickson Building, 5820 University Avenue, Halifax, Nova Scotia B3H 1V8 Canada.
authors.forename: Karthik K
authors.initials: KK
authors.lastname: Tennankore
authors.affiliation: Pharm D. College of Pharmacy, Dalhousie University, Queen Elizabeth II Health Sciences-VG Site, Room 2043, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada.
authors.forename: Christopher J A
authors.initials: CJ
authors.lastname: Daley
keywords: Drug shortage; Hypomagnesemia; In-hospital; Magnesium; Magnesium treatment