Hypermagnesemia in Emergency Medicine Medication
- Author: Nona P Novello, MD; Chief Editor: Erik D Schraga, MD more...
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 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.
These agents increase excretion of magnesium by the kidney.
Acts at loop of Henle to promote loss of magnesium in urine.
Calcium directly antagonizes the effects of magnesium. Reserved for patients with severe or symptomatic hypermagnesemia.
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. 2009 Aug. 10(8):734-43. [Medline].
Kaze Folefack F, Stoermann Chopard C. [Magnesium metabolism disturbances]. Rev Med Suisse. 2007 Mar 7. 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. 2003 Jul-Aug. 58(7-8):465-7. [Medline].
Chang WT, Radin B, McCurdy MT. Calcium, magnesium, and phosphate abnormalities in the emergency department. Emerg Med Clin North Am. 2014 May. 32(2):349-66. [Medline].
Balci AK, Koksal O, Kose A, Armagan E, Ozdemir F, Inal T, et al. General characteristics of patients with electrolyte imbalance admitted to emergency department. World J Emerg Med. 2013. 4(2):113-6. [Medline]. [Full Text].
Lin CH, Tu YF, Chiang WC, Wu SY, Chang YH, Chi CH. Electrolyte abnormalities and laboratory findings in patients with out-of-hospital cardiac arrest who have kidney disease. Am J Emerg Med. 2013 Mar. 31(3):487-93. [Medline].
Agus ZS, Wasserstein A, Goldfarb S. Disorders of calcium and magnesium homeostasis. Am J Med. 1982 Mar. 72(3):473-88. [Medline].
Birrer RB, Shallash AJ, Totten V. Hypermagnesemia-induced fatality following epsom salt gargles(1). J Emerg Med. 2002 Feb. 22(2):185-8. [Medline].
Gigg MA, Wolfson AB, Tayal VS. Electrolyte disturbances. Emergency Medicine Concepts and Clinical Practice. 1998. Vol 3: 2445-8.
Knochel JP. Disorders of magnesium metabolism. Harrison's Principles of Internal Medicine. 1994. Vol 2: 2187-9.
Londner M, Hammer D, Kelen G. Fluid and electrolyte problems. Emergency Medicine Comprehensive Study Guide. 2004. 177-178.
Moe SM. Disorders of calcium, phosphorus, and magnesium. Am J Kidney Dis. 2005 Jan. 45(1):213-8. [Medline].
Nadler JL, Rude RK. Disorders of magnesium metabolism. Clinical Disorders of Fluid and Electrolyte Metabolism. 1995. Vol 24: 623-37.
Qureshi T, Melonakos TK. Acute hypermagnesemia after laxative use. Ann Emerg Med. 1996 Nov. 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. 1995 Nov. 275(2):638-45. [Medline].
Wilson RF, Barton C. Fluid and electrolyte problems. Emergency Medicine Comprehensive Study Guide. 1996. 135-7.