Controversies over the use of magnesium sulfate in delirium tremens

OBJECTIVE: To critically address the controversy of using parenteral magnesium sulfate in delirium tremens (DT). DATA SOURCES: English-language journal articles published between 1954 and 1987. STUDY SELECTION: All literature available, mostly case reports, that either support or discourage magnesium sulfate administration to patients with DT. DATA EXTRACTION: Pertinent information (as judged by the authors) was summarized and interpreted. DATA SYNTHESIS: DT has long been associated with magnesium deficiency because many alcoholic patients with DT have low serum magnesium concentrations. Recent literature, however, suggests that hypomagnesemia is not noted universally in this patient population and that patients' serum magnesium concentrations may return to normal without exogenous magnesium administration. Thus, there is most likely not a specific causal relationship of hypomagnesemia in DT. CONCLUSIONS: Routine administration of parenteral magnesium sulfate in patients with DT is not recommended.