Paudel D. Letter to the Editor: Magnesium supplementation in sepsis: A promising metabolic resuscitation strategy. World J Crit Care Med 2026; 15(3): 120168 [DOI: 10.5492/wjccm.120168]
Corresponding Author of This Article
Damodar Paudel, MD, MSc, Department of Medicine, Nepal Police Hospital, Maharjgunj, Kathmandu 44600, Bāgmatī, Nepal. damodarpaudel@gmail.com
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Critical Care Medicine
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letter
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Paudel D. Letter to the Editor: Magnesium supplementation in sepsis: A promising metabolic resuscitation strategy. World J Crit Care Med 2026; 15(3): 120168 [DOI: 10.5492/wjccm.120168]
World J Crit Care Med. Sep 9, 2026; 15(3): 120168 Published online Sep 9, 2026. doi: 10.5492/wjccm.120168
Letter to the Editor: Magnesium supplementation in sepsis: A promising metabolic resuscitation strategy
Damodar Paudel
Damodar Paudel, Department of Medicine, Nepal Police Hospital, Kathmandu 44600, Bāgmatī, Nepal
Damodar Paudel, Department of Internal Medicine, Nepal Police Hospital, Kathmandu 44600, Bāgmatī, Nepal
Author contributions: Paudel D confirms sole responsibility for all aspects of the editorial, including conception, drafting, and final approval.
Conflict-of-interest statement: The author has no conflict of interest related to the manuscript.
Corresponding author: Damodar Paudel, MD, MSc, Department of Medicine, Nepal Police Hospital, Maharjgunj, Kathmandu 44600, Bāgmatī, Nepal. damodarpaudel@gmail.com
Received: February 24, 2026 Revised: March 30, 2026 Accepted: April 24, 2026 Published online: September 9, 2026 Processing time: 185 Days and 3.9 Hours
Abstract
Sepsis remains a major cause of mortality worldwide despite advances in modern critical care. Elevated serum lactate is a key marker of metabolic dysfunction and is strongly associated with adverse outcomes of sepsis. Magnesium plays a crucial role in mitochondrial function, energy production, and cellular metabolism, and its deficiency is frequently observed in critically ill patients with reduced lactate clearance. The recent randomized controlled trial by Anbarasan et al published in World Journal of Critical Care Medicine provided an important evidence that magnesium supplementation enhance lactate clearance, reduced vasopressor requirements, and shortened both intensive care unit and hospital length of stay of septic patients. Their results are quite promising, but have several limitations. The absence of baseline magnesium measurements makes it difficult to determine whether the observed benefits are resulted from correction of hypomagnesemia or from other pharmacological effects of magnesium. Furthermore, the single-center design with relatively small sample size, and the lack of statistically significant mortality benefit limit the generalizationn of the findings. Overall, magnesium supplementation appears to be a promising, safe, and cost-effective adjunctive therapy for sepsis, large multicenter randomized trials and mechanistic studies are required before recommendation for routine clinical use.
Core Tip: Magnesium is a key co factor in ATP synthesis and mitochondrial electron transport and plays an important role in immune metabolic regulation. Hypomagnesemia impairs cellular energy metabolism and contributes to lactate accumulation, while hepatic dysfunction further compromises lactate clearance. Together, these mechanisms may exacerbate lactic acidosis and worsen outcomes in septic patients.
