Anest. intenziv. Med. 2026;37(1):50-53 | DOI: 10.36290/aim.2026.004

Monitoring of ionized magnesium and its importance for the critically illNew guidelines

Balík M.¹, Duška F.², Černý V.^2-7, Šrámek V.⁸, Matějovič M.⁹, Springer D.¹⁰, Lahoda Brodská H.¹⁰

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha

² Klinika anesteziologie a resuscitace, Fakultní nemocnice Královské Vinohrady, 3. lékařská fakulta Univerzity Karlovy, Praha

³ Klinika anesteziologie, perioperační a intenzivní medicíny, Masarykova nemocnice v Ústí nad Labem, Univerzita J. E. Purkyně v Ústí nad Labem

⁴ Národní institut kvality a excelence zdravotnictví, Praha

⁵ Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Hradci Králové, Univerzita Karlova v Praze

⁶ Department of Anesthesia, Pain Management and and Perioperative Medicine, Dalhousie University, Halifax, Canada

⁷ Ústav klinických oborů a biomedicíny, Technická univerzita Liberec

⁸ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice U sv. Anny, Masarykova univerzita, Brno

⁹ I. interní klinika, Lékařská fakulta v Plzni, Univerzita Karlova a Fakultní nemocnice Plzeň

¹⁰ Ústav lékařské biochemie a laboratorní diagnostiky, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha

Ionised magnesium (Mg2+) represents biologically active form of total plasmatic magnesium and an essential electrolyte with an impact on cellular functions, metabolism, creation of energy substrates (ATP), myocardial electrical stability and the neuromuscular transmission. Critically ill patients face significant changes in acid-base regulation, distribution of body fluids and hormonal regulations, which render traditional estimates of total magnesium levels insufficiently informative and potentially misleading. This collaborative intersocietal position statement summarizes current state-of-the-art scientific and clinical experiences, resulting in recommendations for introduction of a routine Mg2+ measurement in the critical care practice. An availability of Mg2+ measurement in selected groups of patients is desirable in relation to new methods in the intensive care practice and is considerably supported by the known deficit of magnesium in the general population. The Mg2+ estimates are suitable for the intensive care units and the critically ill in Czechia. The prominent indications are especially regional citrate anticoagulation and renal failure, in patients with heart failure and a risk of arrhythmias including perioperative arrhythmias at the complex cardiovascular centres. Furthermore, the measurements are recommended in diabetic and septic patients. Mg2+ should be taken everywhere in shock accompanied with significant shifts in body fluids and acid-base regulation associating with a positive balance of fluids followed by a de-resuscitation phase and a subsequent fluid elimination. The measurement should be available 24/7 as part of the point-of-care analysis similarly as the level of ionised calcium (Ca2+).

Keywords: magnesium, ionised magnesium, intensive care, regional citrate anticoagulation, arrhythmias, heart failure.

Received: January 30, 2026; Revised: January 30, 2026; Accepted: February 4, 2026; Prepublished online: March 9, 2026; Published: April 9, 2026  Show citation