Letter to the Editor: Magnesium supplementation in sepsis: A promising metabolic resuscitation strategy.

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.