Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hypermagnesemia in Emergency Medicine Treatment & Management

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

Emergency Department Care

Although the effectiveness of dialysis in removing divalent cations is debated, some studies have demonstrated removal of a large amount of magnesium using this modality. Dialysis is best used when levels exceed 8 mEq/L, when life-threatening symptoms are present, or in patients with poor renal function.

  • Assess the patient's ABCs and stabilize.
  • Intubate if necessary.
  • Treat hypotension with fluids.
  • Treat arrhythmia as per advanced cardiac life support (ACLS) protocol or with treatment outlined below, if hypermagnesemia is known.
  • Obtain appropriate studies as discussed in Workup.
Next

Consultations

Obtain a renal consultation for dialysis if the patient is severely hypermagnesemic.

Arrange ICU monitoring if the symptoms are severe.

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

  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.

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.