Hypermagnesemia in Emergency Medicine Clinical Presentation
- Author: Nona P Novello, MD; Chief Editor: Erik D Schraga, MD more...
Common causes of hypermagnesemia include renal failure and iatrogenic manipulations. However, other diseases may result in increased magnesium; the degree of elevation determines the symptoms. Acute elevations of magnesium usually are more symptomatic than slow rises.
Magnesium levels of 2-4 mEq/L are associated with the following:
- Skin flushing
High magnesium levels are associated with depressed levels of consciousness, respiratory depression, and cardiac arrest.
Physical findings are related to the serum magnesium levels.
Serum magnesium levels of 3.5-5 mEq/L are associated with the following:
- Disappearance of deep tendon reflexes
- Muscle weakness
Serum magnesium levels of 5-6 mEq/L are related to the following:
Serum magnesium levels of 8-10 mEq/L are associated with the following:
- Arrhythmia, including atrial fibrillation
- Intraventricular conduction delay
- Flaccid skeletal muscle paralysis
Levels of serum magnesium greater than 10 mEq/L are related to the following:
- Heart block
- Ventilatory failure
- Stupor or coma
Elevated levels of magnesium also are associated with the following:
- Delayed thrombin formation
- Platelet clumping
Most cases of hypermagnesemia are due to iatrogenic interventions and administration, especially errors in calculating appropriate infusions. Additional causes include the following:
- Ingestion of magnesium-containing substances such as vitamins, antacids, or cathartics by patients with chronic renal failure
- Acute renal failure (in the absence of dialysis)
- Excessive intravenous infusions of magnesium in patients being treated for eclampsia, asthma, torsade de pointes, or other cardiac arrhythmias
- In neonates, treatment of maternal eclampsia with magnesium, which passes through the placental circulation
- Decreased GI elimination and increased GI absorption of magnesium due to intestinal hypomotility from any cause
- GI medications that decrease motility, including narcotics and anticholinergics
- Hypomotility disorders such as bowel obstruction and chronic constipation
- Tumor lysis syndrome, by releasing massive amounts of intracellular magnesium
- Adrenal insufficiency (secondary hypermagnesemia)
- Rhabdomyolysis, like tumor lysis syndrome, by releasing significant amounts of intracellular magnesium
- Neoplasm with skeletal muscle involvement
- Extracellular volume contraction, as in diabetic ketoacidosis (DKA)
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