Hypermagnesemia

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Background

  • High >3.5
  • Magnesium is an effective calcium channel blocker both extracellularly and intracellularly[1]
  • Intracellular magnesium profoundly blocks several cardiac potassium channels.

Diagnosis

  • 2–3 - Nausea
  • 3–4 - Somnolence
  • 4–8 - Loss of DTRs
  • 8–12 - Respiratory depression
  • 12–15 - Hypotension, heart block, Cardiac Arrest

Differential Diagnosis

  1. Renal Failure
  2. Lithium
  3. Volume depletion
  4. Rhabdo
  5. IV Mg (goal in PET/eclampsia 5-7 mEq/L)
  6. Massive PO intake (laxative abusers, accidental Epsom salts)
  7. Magnesium enemas[2]

Treatment

  • 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

See Also

Source

  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.
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