Hypermagnesemia: Difference between revisions
| Line 33: | Line 33: | ||
==Evaluation== | ==Evaluation== | ||
*Magnesium level | *Magnesium level >3.5 | ||
==Management== | ==Management== | ||
Revision as of 06:40, 22 May 2017
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