Hypermagnesemia in Emergency Medicine Medication
- Author: Nona P Novello, MD; Chief Editor: Erik D Schraga, MD more...
Medication Summary
Treatment depends upon the level of magnesium and the presence of symptoms. In patients with mildly increased levels, simply stop the source of magnesium. In patients with higher concentrations or severe symptoms, other treatments are necessary. Calcium should be reserved for patients with life-threatening symptoms, such as arrhythmia or severe respiratory depression.
Intravenous fluids
Class Summary
Intravenous fluids work by dilution of the extracellular magnesium. Fluids are used with diuretics to promote increased excretion of magnesium by the kidney.
Normal saline or lactated Ringer solution
Both fluids are essentially isotonic, and, while some of their metabolic effects differ, the differences are clinically irrelevant for the purpose of promoting diuresis.
Diuretics
Class Summary
These agents increase excretion of magnesium by the kidney.
Furosemide (Lasix)
Acts at loop of Henle to promote loss of magnesium in urine.
Mineral supplements
Class Summary
Calcium directly antagonizes the effects of magnesium. Reserved for patients with severe or symptomatic hypermagnesemia.
Calcium gluconate (Kalcinate)
Directly antagonizes neuromuscular and cardiovascular effects of magnesium. The 10% IV solution provides 100 mg/mL of calcium gluconate that equals 9 mg/mL (0.46 mEq/mL) of elemental calcium. One 10 mL ampule contains 93 mg of elemental calcium.
Soave PM, Conti G, Costa R, Arcangeli A. Magnesium and anaesthesia. Curr Drug Targets. Aug 2009;10(8):734-43. [Medline].
Kaze Folefack F, Stoermann Chopard C. [Magnesium metabolism disturbances]. Rev Med Suisse. Mar 7 2007;3(101):605-6, 608, 610-1. [Medline].
Musso CG. Magnesium metabolism in health and disease. Int Urol Nephrol. 2009;41(2):357-62. [Medline].
Guillaume T, Krzesinski JM. [Management of serum magnesium abnormalities]. Rev Med Liege. Jul-Aug 2003;58(7-8):465-7. [Medline].
Agus ZS, Wasserstein A, Goldfarb S. Disorders of calcium and magnesium homeostasis. Am J Med. Mar 1982;72(3):473-88. [Medline].
Birrer RB, Shallash AJ, Totten V. Hypermagnesemia-induced fatality following epsom salt gargles(1). J Emerg Med. Feb 2002;22(2):185-8. [Medline].
Gigg MA, Wolfson AB, Tayal VS. Electrolyte disturbances. In: Emergency Medicine Concepts and Clinical Practice. Vol 3. 1998:2445-8.
Knochel JP. Disorders of magnesium metabolism. In: Harrison's Principles of Internal Medicine. Vol 2. 1994:2187-9.
Londner M, Hammer D, Kelen G. Fluid and electrolyte problems. In: Emergency Medicine Comprehensive Study Guide. 2004:177-178.
Moe SM. Disorders of calcium, phosphorus, and magnesium. Am J Kidney Dis. Jan 2005;45(1):213-8. [Medline].
Nadler JL, Rude RK. Disorders of magnesium metabolism. In: Clinical Disorders of Fluid and Electrolyte Metabolism. Vol 24. 1995:623-37.
Qureshi T, Melonakos TK. Acute hypermagnesemia after laxative use. Ann Emerg Med. Nov 1996;28(5):552-5. [Medline].
Usowicz MM, Gigg M, Jones LM. Allosteric interactions at L-type calcium channels between FPL 64176 and the enantiomers of the dihydropyridine Bay K 8644. J Pharmacol Exp Ther. Nov 1995;275(2):638-45. [Medline].
Wilson RF, Barton C. Fluid and electrolyte problems. In: Emergency Medicine Comprehensive Study Guide. 1996:135-7.

