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Hypermagnesemia

Thu, 12/20/2007 - 20:33 — oxygen
Hypermagnesemia Listen to Audio General role of magnesium Causes of Hypermagnesemia Clinical manifestations of hypermagnesemia Treatment of hypermagenesemia Anesthetic considersations GENERAL ROLE OF MAGNESIUM 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 CAUSES OF HYPERMAGNESEMIA -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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