SummaryThree children with familial hypomagnesemia from infancy were treated perorally with magnesium for 9 to 12 years. Their somatic and intellectual development have since been normal. Without therapy, the serum magnesium fell from subnormal (about 0.5 mmoles/liter) to very low values (0.2 to 0.3 mmoles/liter) within 1 to 4 wk. We observed a secondary fall in serum calcium and potassium and an increase in sodium and phosphate although serum concentrations of PTH, calcitonin, and 25‐OH‐vitamin D in the blood remained normal. Balance studies confirmed the presence of a defect in the intestinal absorption of magnesium and excluded a defective renal tubular transport system. The subjects continued to require daily magnesium supplements to avoid serious symptoms. Optimal dosage was found to be in the range 0.5 to 0.75 mmoles/kg·day; doses above this caused diarrhoea and a fall in the serum and urine levels of magnesium. Pathophysiologic mechanisms involved in the electrolyte changes that occurred secondarily to the hypomagnesemia are discussed.SpeculationThe pathophysiologic basis for the impaired intestinal absorption of magnesium in this condition is unknown. In fact, the mechanism by which magnesium is normally transported across membranes is also largely unknown. A facilitated transport mechanism seems to be involved. It appears reasonable to believe that errors in enzymes, or perhaps more likely, in specific magnesiumbinding proteins that are involved in the membrane transport form the molecular basis for familial hypomagnesemia.