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Hypermagnesemia in Emergency Medicine Clinical Presentation

  • Author: Nona P Novello, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Dec 17, 2014
 

History

Common causes of hypermagnesemia include renal failure and iatrogenic manipulations.[5] 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:

  • Nausea
  • Vomiting
  • Skin flushing
  • Weakness
  • Lightheadedness

High magnesium levels are associated with depressed levels of consciousness, respiratory depression, and cardiac arrest.

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Physical

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:

  • Hypotension
  • Vasodilatation

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:

  • Asystole
  • Heart block
  • Ventilatory failure
  • Stupor or coma
  • Death

Elevated levels of magnesium also are associated with the following:

  • Delayed thrombin formation
  • Platelet clumping
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Causes

Most cases of hypermagnesemia are due to iatrogenic interventions and administration,[1] 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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Contributor Information and Disclosures
Author

Nona P Novello, MD Chief Medical Information Officer, MedStar Franklin Square Medical Center

Nona P Novello, MD is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership, Phi Beta Kappa, Healthcare Information and Management Systems Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Joseph J Sachter, MD, FACEP Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Howard A Blumstein, MD, FAAEM Assistant Professor of Surgery, Medical Director, Department of Emergency Medicine, Wake Forest University School of Medicine

Howard A Blumstein, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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