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Hypermagnesemia in Emergency Medicine Medication

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

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.

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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.

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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.

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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.

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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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