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Hypermagnesemia in Emergency Medicine

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

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]

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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]

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Epidemiology

Frequency

United States

Hypermagnesemia occurs only rarely in the United States.

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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.

References
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  2. Kaze Folefack F, Stoermann Chopard C. [Magnesium metabolism disturbances]. Rev Med Suisse. 2007 Mar 7. 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. 2003 Jul-Aug. 58(7-8):465-7. [Medline].

  5. 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].

  6. 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].

  7. 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].

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

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

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

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

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

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

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

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

  16. 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].

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

 
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