Hypermagnesemia

Hypermagnesemia
Mg-TableImage.png
Magnesium
Specialty Endocrinology
Symptoms Weakness, confusion, decreased breathing rate[1]
Complications Cardiac arrest[1]
Causes Kidney failure, treatment induced, tumor lysis syndrome, seizures, prolonged ischemia[2][1]
Diagnostic method Blood level > 1.1 mmol/L (2.6 mg/dL)[1][3]
Treatment Calcium chloride, intravenous normal saline with furosemide, hemodialysis[1]
Frequency Uncommon[3]

Hypermagnesemia is an electrolyte disorder in which there is a high level of magnesium in the blood.[3] Symptoms include weakness, confusion, decreased breathing rate, and decreased reflexes.[1][3] Complications may include low blood pressure and cardiac arrest.[4][1]

It is typically caused by kidney failure or is treatment induced such as from antacids that contain magnesium.[1][5] Less common causes include tumor lysis syndrome, seizures, and prolonged ischemia.[2] Diagnosis is based on a blood level greater than 1.1 mmol/L (2.6 mg/dL).[1][3] It is severe if levels are greater than 2.9 mmol/L (7 mg/dL).[4] Specific electrocardiogram (ECG) changes may be present.[1]

Treatment involves stopping the magnesium a person is getting.[2] Treatment when levels are very high include calcium chloride, intravenous normal saline with furosemide, and hemodialysis.[1] Hypermagnesemia is uncommon.[3] Rates may be as high as 10% among those in hospital.[2]

Signs and symptoms[edit]

Abnormal heart rhythms and asystole are possible complications of hypermagnesemia related to the heart.[8] Magnesium acts as a physiologic calcium blocker, which results in electrical conduction abnormalities within the heart.

Clinical consequences related to serum concentration:

Note that the therapeutic range for the prevention of the pre-eclampsic uterine contractions is: 4.0-7.0 mEq/L.[9] As per Lu and Nightingale,[10] serum Mg2+ concentrations associated with maternal toxicity (also neonate depression – hypotonia and low Apgar scores) are:

  • 7.0-10.0 mEq/L – loss of patellar reflex
  • 10.0-13.0 mEq/L – respiratory depression
  • 15.0-25.0 mEq/L – altered atrioventricular conduction and (further) complete heart block
  • >25.0 mEq/L – cardiac arrest

Causes[edit]

Magnesium status depends on three organs: uptake in the intestine, storage in the bone and excretion in the kidneys. Hypermagnesemia is therefore often due to problems in these organs, mostly intestine or kidney.[11]

Predisposing conditions[edit]

Metabolism[edit]

For a detailed description of magnesium homeostasis and metabolism see hypomagnesemia.

Diagnosis[edit]

Hypermagnesemia is diagnosed by measuring the concentration of magnesium in the blood. Concentrations of magnesium greater than 1.1 mmol/L are considered diagnostic.[1]

Treatment[edit]

Prevention of hypermagnesemia usually is possible. In mild cases, withdrawing magnesium supplementation is often sufficient. In more severe cases the following treatments are used:

Definitive treatment of hypermagnesemia requires increasing renal magnesium excretion through:

  • Intravenous diuretics, in the presence of normal kidney function
  • Dialysis, when kidney function is impaired and the patient is symptomatic from hypermagnesemia

References[edit]

  1. ^ a b c d e f g h i j k l Soar, J; Perkins, GD; Abbas, G; Alfonzo, A; Barelli, A; Bierens, JJ; Brugger, H; Deakin, CD; Dunning, J; Georgiou, M; Handley, AJ; Lockey, DJ; Paal, P; Sandroni, C; Thies, KC; Zideman, DA; Nolan, JP (October 2010). “European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution”. Resuscitation. 81 (10): 1400–33. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045.
  2. ^ a b c d Ronco, Claudio; Bellomo, Rinaldo; Kellum, John A.; Ricci, Zaccaria (2017). Critical Care Nephrology. Elsevier Health Sciences. p. 344. ISBN 9780323511995.
  3. ^ a b c d e f “Hypermagnesemia”. Merck Manuals Professional Edition. Retrieved 28 October 2018.
  4. ^ a b Lerma, Edgar V.; Nissenson, Allen R. (2011). Nephrology Secrets. Elsevier Health Sciences. p. 568. ISBN 0323081274.
  5. ^ Romani, Andrea, M.P. (2013). “Chapter 3. Magnesium in Health and Disease”. In Astrid Sigel; Helmut Sigel; Roland K. O. Sigel (eds.). Interrelations between Essential Metal Ions and Human Diseases. Metal Ions in Life Sciences. 13. Springer. pp. 49–79. doi:10.1007/978-94-007-7500-8_3.
  6. ^ Cholst, IN; Steinberg, SF; Tropper, PJ; Fox, HE; Segre, GV; Bilezikian, JP (10 May 1984). “The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects”. New England Journal of Medicine. 310 (19): 1221–5. doi:10.1056/NEJM198405103101904. PMID 6709029. Retrieved 25 April 2019.
  7. ^ Khairi, Talal; Amer, Syed; Spitalewitz, Samuel; Alasadi, Lutfi (6 January 2014). “Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus”. Case Reports in Nephrology. doi:10.1155/2014/560746. PMID 24563801. Retrieved 25 April 2019.
  8. ^ Schelling, JR (January 2000). “Fatal hypermagnesemia”. Clinical Nephrology. 53 (1): 61–5. PMID 10661484. Retrieved 25 April 2019.
  9. ^ Pritchard JA (1955). “The use of the magnesium ion in the management of eclamptogenic toxemias”. Surg Gynecol Obstet. 100: 131–140.
  10. ^ Lu JF, Nightingale CH (2000). “Magnesium sulfate in eclampsia and pre-eclampsia”. Clin Pharmacokinet. 38: 305–314. doi:10.2165/00003088-200038040-00002. PMID 10803454.
  11. ^ Jahnen-Dechent W, Ketteler M (2012). “Magnesium basics” (PDF). Clin Kidney J. 5 (Suppl 1): i3–i14. doi:10.1093/ndtplus/sfr163.

External links[edit]

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External resources