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HWN Suggests

Magnum, P.I.

Most reports of hypermagnesemia are iatrogenic in nature.

• Magnesium sulfate infusion for patients with preeclampsia/eclampsia.
• The use of magnesium sulfate with charcoal as a cathartic for overdose patients. This practice was stopped after numerous case reports in the 1970s and 1980s.
• Magnesium citrate, Milk of Magnesia (magnesium hydroxide), and magnesium sulfate enemas for constipation.

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 Causes of Hypermagnesaemia: A Literature Review

This review assesses the latest advancements in knowledge of magnesium metabolism, examines the case reports of hypermagnesaemia in an attempt to list the causes of magnesium toxicity, and enumerates management advances for the condition.

Articles of Interest

An Unnoticed Case; Hypermagnesemia at the Emergency Department

Introduction. Hypermagnesemia generally develops in people with renal function disorders or due to exogen Mg intake for constipation. Hospitalized cases of fatal hypermagnesemia are rare in the literature.

Hypermagnesium

The causes of hypermagnesemia are varied but are usually due to iatrogenic interventions.

Magnesium Toxicity with Prolonged QT

The differential for a prolonged QT interval is broad, and includes electrolyte abnormalities, antiarrhythmic medications, antibiotics, psychotropic medications, gastric motility agents, and antihistamines. While hypomagnesemia is a more common cause of conduction abnormalities, hypermagnesemia can be seen in failures of excretion such as in renal failure, or excessive intake such as during hyper-alimentation.

Resources

EMCrit

Wide QRS and peaked T-waves (can mimic hyperkalemia). IV calcium may stabilize myocardium. Two grams of calcium gluconate IV over 5-10 minutes (or one gram of calcium chloride). May need to repeat or, in extreme cases, give as a continuous infusion.

Life in the Fastlane

ECG (as for hyperkalaemia)...