Hypermagnesemia: Difference between revisions
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*Magnesium is an effective calcium channel blocker both extracellularly and intracellularly<ref>Rizzo MA, Fisher M, Lock JP. Hypermagnesemic pseudocoma. Arch Intern Med. 1993;153(9):1130.</ref> | *Magnesium is an effective calcium channel blocker both extracellularly and intracellularly<ref>Rizzo MA, Fisher M, Lock JP. Hypermagnesemic pseudocoma. Arch Intern Med. 1993;153(9):1130.</ref> | ||
*Intracellular magnesium profoundly blocks several cardiac potassium channels | *Intracellular magnesium profoundly blocks several cardiac potassium channels | ||
==Clinical Features== | ==Clinical Features== | ||
* | *[[Nausea and vomiting]] | ||
*Loss of reflexes and [[respiratory failure|diaphragmatic paralysis]] (at very high levels) | |||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| Line 37: | Line 22: | ||
| 12-15 || [[Hypotension]], [[heart block]], [[Cardiac Arrest]], death | | 12-15 || [[Hypotension]], [[heart block]], [[Cardiac Arrest]], death | ||
|} | |} | ||
==Differential Diagnosis== | |||
*[[Renal Failure]] | |||
*[[Lithium]] | |||
*[[hypovolemia|Volume depletion]] | |||
*[[Rhabdo]] | |||
*IV Mg (goal in PET/[[eclampsia]] 5-7 mEq/L) | |||
*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> | |||
==Evaluation== | |||
*Magnesium level >3.5 | |||
==Management== | ==Management== | ||
*[[IVF]] | *[[IVF]] | ||
*Furosemide 20-40mg | *[[Furosemide]] 20-40mg IV | ||
* | *[[Calcium chloride]] 10% 5-10mL IV or [[calcium gluconate]] 10% 15-30mL IV over 5min | ||
*Consider | *Consider hemodialysis for Mg >8 or poor renal function | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Electrolyte Abnormalities (Main)]] | *[[Electrolyte Abnormalities (Main)]] | ||
*[[Hypomagnesemia]] | *[[Hypomagnesemia]] | ||
*[[Preeclampsia]] | |||
*[[QT prolongation]] | |||
==References== | ==References== | ||
Latest revision as of 23:35, 23 February 2021
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