We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Difference between revisions of "Hypermagnesemia"
From WikEM
Neil.m.young (Talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
(→Background) |
||
| Line 3: | Line 3: | ||
*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 | ||
| + | |||
| + | ===Causes of Hypermagnesemia=== | ||
| + | *Renal insufficiency | ||
| + | *IV magnesium infusion (e.g. in pregnancy/preeclampsia) | ||
| + | *Oral ingestion, esp. if there is renal insufficiency | ||
| + | ** Epsom salts, laxatives | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 10:10, 8 May 2017
Contents
Background
- High >3.5
- Magnesium is an effective calcium channel blocker both extracellularly and intracellularly[1]
- Intracellular magnesium profoundly blocks several cardiac potassium channels
Causes of Hypermagnesemia
- Renal insufficiency
- IV magnesium infusion (e.g. in pregnancy/preeclampsia)
- Oral ingestion, esp. if there is renal insufficiency
- Epsom salts, laxatives
Clinical Features
- Symptoms may be mild nausea and vomiting initially to diaphragmatic paralysis as the Mg concentration increases
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
| 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 |
Management
- IVF (NS)
- Furosemide 20-40mg IVP
- CaCl 10% 5-10mL IV or Ca gluconate 10% 15-30mL IV over 5min
- Consider HD for Mg > 8 or poor renal function
