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Difference between revisions of "Hypermagnesemia"
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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 | ||
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==Clinical Features== | ==Clinical Features== | ||
| − | * | + | *Nausea and vomiting |
| + | *Loss of reflexes and diaphragmatic paralysis (at very high levels) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
| − | *[[IVF]] | + | *[[IVF]] |
| − | *Furosemide 20-40mg | + | *Furosemide 20-40mg IV |
*CaCl 10% 5-10mL IV or Ca gluconate 10% 15-30mL IV over 5min | *CaCl 10% 5-10mL IV or Ca gluconate 10% 15-30mL IV over 5min | ||
| − | *Consider HD for Mg > 8 or poor renal function | + | *Consider HD for Mg >8 or poor renal function |
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| + | ==Disposition== | ||
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==See Also== | ==See Also== | ||
Latest revision as of 01:38, 10 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
Clinical Features
- Nausea and vomiting
- Loss of reflexes and diaphragmatic paralysis (at very high levels)
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
- Furosemide 20-40mg IV
- CaCl 10% 5-10mL IV or Ca gluconate 10% 15-30mL IV over 5min
- Consider HD for Mg >8 or poor renal function
