Hypermagnesemia in Emergency Medicine 

  • Author: Nona P Novello, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Jan 22, 2010
 

Background

Magnesium is one of the body's major electrolytes. As the second most common intracellular cation, it plays a vital role in many cellular metabolic pathways.[1] Magnesium is required for deoxyribonucleic acid (DNA) and protein synthesis. It is a necessary cofactor for most enzymes in phosphorylation reactions. It is also important for parathyroid hormone synthesis.

The total body content of this central cation is 2000 mEq, or 24 g. The magnesium is distributed in bone (67%), intracellularly (31%), and extracellularly (a mere 1%).[2] The intracellular concentration is 40 mEq/L, while the normal serum concentration is 1.5-2.0 mEq/L. Of this serum component, 25-30% is protein bound, 10-15% is complexed, and the remaining 50-60% is ionized.

Magnesium is absorbed in the ileum and excreted in stool and urine. The minimum daily requirement of magnesium is 300-350 mg, or 15 mmol; this amount is easily obtainable with a normal daily intake of fruits, seeds, and vegetables because magnesium is a component of chlorophyll and is present in high concentrations in all green plants.

The kidney is the main regulator of magnesium concentrations. Absorption occurs primarily in the proximal tubule and thick ascending limb of the loop of Henle.

Hypermagnesemia is a rare electrolyte abnormality because the kidney is very effective in excreting excess magnesium.[3]

Next

Pathophysiology

Magnesium excess affects the CNS, neuromuscular, and cardiac organ systems. It most commonly is observed in renal insufficiency and in patients receiving intravenous (IV) magnesium for treatment of a medical condition.[4]

Previous
Next

Epidemiology

Frequency

United States

Hypermagnesemia occurs only rarely in the United States.

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Nona P Novello, MD  Associate Chair, Department of Emergency Medicine, Franklin Square Hospital

Nona P Novello, MD is a member of the following medical societies: American College of Emergency Physicians and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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 College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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.

References

  1. Soave PM, Conti G, Costa R, Arcangeli A. Magnesium and anaesthesia. Curr Drug Targets. Aug 2009;10(8):734-43. [Medline].

  2. Kaze Folefack F, Stoermann Chopard C. [Magnesium metabolism disturbances]. Rev Med Suisse. Mar 7 2007;3(101):605-6, 608, 610-1. [Medline].

  3. Musso CG. Magnesium metabolism in health and disease. Int Urol Nephrol. 2009;41(2):357-62. [Medline].

  4. Guillaume T, Krzesinski JM. [Management of serum magnesium abnormalities]. Rev Med Liege. Jul-Aug 2003;58(7-8):465-7. [Medline].

  5. Agus ZS, Wasserstein A, Goldfarb S. Disorders of calcium and magnesium homeostasis. Am J Med. Mar 1982;72(3):473-88. [Medline].

  6. Birrer RB, Shallash AJ, Totten V. Hypermagnesemia-induced fatality following epsom salt gargles(1). J Emerg Med. Feb 2002;22(2):185-8. [Medline].

  7. Gigg MA, Wolfson AB, Tayal VS. Electrolyte disturbances. In: Emergency Medicine Concepts and Clinical Practice. Vol 3. 1998:2445-8.

  8. Knochel JP. Disorders of magnesium metabolism. In: Harrison's Principles of Internal Medicine. Vol 2. 1994:2187-9.

  9. Londner M, Hammer D, Kelen G. Fluid and electrolyte problems. In: Emergency Medicine Comprehensive Study Guide. 2004:177-178.

  10. Moe SM. Disorders of calcium, phosphorus, and magnesium. Am J Kidney Dis. Jan 2005;45(1):213-8. [Medline].

  11. Nadler JL, Rude RK. Disorders of magnesium metabolism. In: Clinical Disorders of Fluid and Electrolyte Metabolism. Vol 24. 1995:623-37.

  12. Qureshi T, Melonakos TK. Acute hypermagnesemia after laxative use. Ann Emerg Med. Nov 1996;28(5):552-5. [Medline].

  13. 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].

  14. Wilson RF, Barton C. Fluid and electrolyte problems. In: Emergency Medicine Comprehensive Study Guide. 1996:135-7.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.