Hypermagnesemia: Difference between revisions

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*High >3.5
*High >3.5
*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


==Diagnosis==
==Clinical Features==
*2–3 - Nausea
*[[Nausea and vomiting]]
*3–4 - [[Somnolence]]
*Loss of reflexes and [[respiratory failure|diaphragmatic paralysis]] (at very high levels)
*4–8 - Loss of DTRs
 
*8–12 - Respiratory depression
{| class="wikitable"
*12–15 - Hypotension, heart block, [[Cardiac Arrest]]
|-
! 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==
==Differential Diagnosis==
#[[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)<ref>Schelling Fatal hypermagnesemia. JR1. Clin Nephrol. 2000 Jan;53(1):61-5.</ref>
*Massive PO intake ([[bulimia nervosa|laxative abusers]], accidental Epsom salts)
#Magnesium enemas
*Magnesium enemas<ref>Schelling Fatal hypermagnesemia. JR1. Clin Nephrol. 2000 Jan;53(1):61-5.</ref>
 
==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


==Treatment==
==Disposition==
#[[IVF]] (NS)
#Furosemide 20-40mg IVP
#CaCl 10% 5mL IV over 5min
#Consider HD for Mg > 8 or poor renal function


==See Also==
==See Also==
*[[Electrolyte Abnormalities (Main)]]
*[[Electrolyte Abnormalities (Main)]]
*[[Hypomagnesemia]]
*[[Hypomagnesemia]]
*[[Preeclampsia]]
*[[QT prolongation]]


==Source ==
==References==
<references/>
<references/>


[[Category:FEN]]
[[Category:FEN]]
[[Category:Tox]]
[[Category:Toxicology]]

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

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

Evaluation

  • Magnesium level >3.5

Management

Disposition

See Also

References

  1. Rizzo MA, Fisher M, Lock JP. Hypermagnesemic pseudocoma. Arch Intern Med. 1993;153(9):1130.
  2. Schelling Fatal hypermagnesemia. JR1. Clin Nephrol. 2000 Jan;53(1):61-5.