Hypermagnesemia
Hypermagnesemia
General role of magnesium
Causes of Hypermagnesemia
Clinical manifestations of hypermagnesemia
Treatment of hypermagenesemia
Anesthetic considersations
Intracellular cation involved in:
cofactor in many enzymatic pathways
Total body magnesium distribution:
67% of total body magnesium content within bone
31% of total body magnesium content located intracellular
1 2 % of total body magnesium content located within the extracellular fluid
Balance of magnesium involves:
Intake:
20 – 30 mEq/day
240 – 370 mg/day
30 – 40% of magnesium is absorbed within the distal portion of small bowel
Elimination:
renal excretion is the primary route of elimination of magnesium
renal excretion 6 –12 mEq/day
efficient reabsorption of magnesium by the kidneys
25% of filtered magnesium is reabsorbed in the PCT
50-60% of filtered magnesium is reabsorbed by the thick limb of the LOH
Factors which increase magnesium reabsorption by the kidneys include:
-hypomagnesemia
-parathyroid hormone (PTH)
-hypocalcemia
-extracellular fluid depletion
-metabolic acidosis
Factors which increase renal excretion of magnesium include:
-hypermagnesemia
-acute volume expansion
-hyperaldosteronism
-hypercalcemia
-ketoacidosis
-excessive intake of magnesium
ex. magnesium containing antacids (laxatives)
-renal impairment of magnesium
ex. GFR < 30 ml/min
-magnesium sulfate therapy
ex. therapy for gestational hypertension
Other causes of hypermagnesemia include:
-adrenal insufficiency
-hypothyroidism
-rhabdomyolysis
-lithium administration
CLINICAL MANIFESTATIONS OF HYPERMAGNESEMIA
Central nervous system:
-hyporeflexia
-sedation
Cardiovascular system:
magnesium levels > 10 mg/dL:
-decreased MAP
magnesium levels > 24 mg/dL:
-myocardial depression
-vasodilation
-bradycardia
ecg changes may include:
-prolonged PR interval
-widening of QRS complex
Respiratory system:
-respiratory arrest with marked hypermagnesium
Neuromuscular system:
-skeletal muscle weakness
TREATMENT OF HYPERMAGNESEMIA
-discontinue magnesium intake
-intravenous calcium gluconate 1 gm may anatagonize the effects hypermagnesemia temporarily
-loop diuretics + ½ normal saline with dextrose may enhance urinary magnesium excretion
-dialysis for marked renal impairment
ANESTHETIC CONSIDERATIONS IN HYPERMAGNESEMIA
May require close monitoring of:
-blood pressure
-electrocardiogram
-neuromuscular junction function
-urinary foley catherization
-muscle relaxants should be reduced by 20 – 25% of regular dosing
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Hypermagnesemia occurs rarely because the kidney is very effective in excreting excess magnesium. It usually develops only in people with kidney failure who are given magnesium salts or who take drugs that contain magnesium (e.g. some antacids and laxatives).
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Hypermagnesemia occurs rarely because the kidney is very effective in excreting excess magnesium. It usually develops only in people with kidney failure who are given magnesium salts or who take drugs that contain magnesium (e.g. some antacids and laxatives). It is usually concurrent with hypercalcemia and/or hyperkalemia.
magnesium oil
I saw that you speak about magnesium here. I was a person that had some problems with a magnesium deficit when I was a little child. I used to take 3 times/day some kind of magnesium oil. It was good for me and now I'm healthy and happy. Hope that in the future, technology will help us more and more so we don't have the problems I had as a child.