Hypermagnesemia: Difference between revisions
(Add MedicationDose entries (furosemide, calcium chloride, calcium gluconate) with SMW annotations) |
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==Clinical Features== | ==Clinical Features== | ||
*[[Nausea and vomiting]] | *[[Nausea and vomiting]] | ||
*Loss of reflexes and diaphragmatic paralysis (at very high levels) | *Loss of reflexes and [[respiratory failure|diaphragmatic paralysis]] (at very high levels) | ||
{| class="wikitable" | {| class="wikitable" | ||
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*[[Renal Failure]] | *[[Renal Failure]] | ||
*[[Lithium]] | *[[Lithium]] | ||
*Volume depletion | *[[hypovolemia|Volume depletion]] | ||
*[[Rhabdo]] | *[[Rhabdo]] | ||
*IV Mg (goal in PET/eclampsia 5-7 mEq/L) | *IV Mg (goal in PET/[[eclampsia]] 5-7 mEq/L) | ||
*Massive PO intake (laxative abusers, accidental Epsom salts) | *Massive PO intake ([[bulimia nervosa|laxative abusers]], accidental Epsom salts) | ||
*Magnesium enemas<ref>Schelling Fatal hypermagnesemia. JR1. Clin Nephrol. 2000 Jan;53(1):61-5.</ref> | *Magnesium enemas<ref>Schelling Fatal hypermagnesemia. JR1. Clin Nephrol. 2000 Jan;53(1):61-5.</ref> | ||
==Evaluation== | ==Evaluation== | ||
*Magnesium level | *Magnesium level >3.5 | ||
==Management== | ==Management== | ||
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*[[Calcium chloride]] 10% 5-10mL IV or [[calcium gluconate]] 10% 15-30mL IV over 5min | *[[Calcium chloride]] 10% 5-10mL IV or [[calcium gluconate]] 10% 15-30mL IV over 5min | ||
*Consider hemodialysis for Mg >8 or poor renal function | *Consider hemodialysis for Mg >8 or poor renal function | ||
==Medication Dosing== | |||
{{MedicationDose | |||
| drug = Furosemide | |||
| dose = 20-40mg | |||
| route = IV | |||
| context = Promote renal magnesium excretion | |||
| indication = Hypermagnesemia | |||
| population = Adult | |||
}} | |||
{{MedicationDose | |||
| drug = Calcium chloride | |||
| dose = 5-10mL of 10% solution | |||
| route = IV | |||
| context = Antagonize cardiac/respiratory effects of hypermagnesemia | |||
| indication = Hypermagnesemia | |||
| population = Adult | |||
| notes = Administer over 5 minutes | |||
}} | |||
{{MedicationDose | |||
| drug = Calcium gluconate | |||
| dose = 15-30mL of 10% solution | |||
| route = IV | |||
| context = Antagonize cardiac/respiratory effects of hypermagnesemia (alternative to calcium chloride) | |||
| indication = Hypermagnesemia | |||
| population = Adult | |||
| notes = Administer over 5 minutes | |||
}} | |||
==Disposition== | ==Disposition== | ||
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*[[Electrolyte Abnormalities (Main)]] | *[[Electrolyte Abnormalities (Main)]] | ||
*[[Hypomagnesemia]] | *[[Hypomagnesemia]] | ||
*[[Preeclampsia]] | |||
*[[QT prolongation]] | |||
==References== | ==References== | ||
Latest revision as of 18:23, 20 March 2026
Background
- High >3.5
- Magnesium is an effective calcium channel blocker both extracellularly and intracellularly[1]
- Intracellular magnesium profoundly blocks several cardiac potassium channels
Clinical Features
- Nausea and vomiting
- Loss of reflexes and diaphragmatic paralysis (at very high levels)
| Mg Level | Signs/Symptoms |
|---|---|
| 2-3 | Nausea |
| 3-4 | Somnolence |
| 4-8 | Loss of DTRs, muscle weakness |
| 8-12 | Respiratory depression |
| 12-15 | Hypotension, heart block, Cardiac Arrest, death |
Differential Diagnosis
- Renal Failure
- Lithium
- Volume depletion
- Rhabdo
- IV Mg (goal in PET/eclampsia 5-7 mEq/L)
- Massive PO intake (laxative abusers, accidental Epsom salts)
- Magnesium enemas[2]
Evaluation
- Magnesium level >3.5
Management
- IVF
- Furosemide 20-40mg IV
- Calcium chloride 10% 5-10mL IV or calcium gluconate 10% 15-30mL IV over 5min
- Consider hemodialysis for Mg >8 or poor renal function
Medication Dosing
Furosemide 20-40mg IV Calcium chloride 5-10mL of 10% solution IV — Administer over 5 minutes Calcium gluconate 15-30mL of 10% solution IV — Administer over 5 minutes