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One hundred people were missing, and hundreds were injured.
The quake, which hit at 10:35 am (local time) in the midst of the work day, caused terror over an unusually wide area, with damage reported in all but one of Guatemala's 22 states and shaking felt as far away as Mexico City, 600 miles (965 kilometers) to the northwest.
President Otto Perez Molina said at a news conference that 40 people died in the province of San Marcos and eight more were killed in the neighbouring province of Quetzaltenango.
San Marcos, where more than 30 homes collapsed, bore the brunt of the temblor's fury.
More than 300 people, including firefighters, policemen and villagers, tried to dig through a half ton of sand at a quarry in the commercial center of town in a desperate attempt to rescue seven people believed buried alive. Among those under the sand was a 6-year-old boy who had accompanied his grandfather to work.
"I want to see Giovanni! I want to see Giovanni!" the boy's mother, 42-year-old Francisca Ramirez, frantically cried. "He's not dead. Get him out." She said the boy's father had emigrated to the US and there was no way to reach him.
