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| {{CMG}} | | {{CMG}} |
| | ==[[Hypermagnesemia overview|Overview]]== |
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| '''Hypermagnesemia''' is an [[electrolyte disturbance]] in which there is an abnormally elevated level of [[magnesium]] in the blood. Usually this results in excess of magnesium in the body.
| | ==[[Hypermagnesemia historical perspective|Historical Perspective]]== |
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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 [[antacid]]s and [[laxative]]s). It is usually concurrent with [[hypercalcemia]] and/or [[hyperkalemia]].
| | ==[[Hypermagnesemia pathophysiology|Pathophysiology]]== |
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| ==Metabolism== | | ==[[Hypermagnesemia causes|Causes]]== |
| For a detailed description of magnesium [[homeostasis]] and [[metabolism]] see [[hypomagnesemia]].
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| ==Symptoms== | | ==[[Hypermagnesemia epidemiology and demographics|Epidemiology and Demographics]]== |
| * Weakness, nausea and vomiting
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| * [[Hypotension]]
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| * Impaired breathing
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| * [[Arrhythmia]] and [[asystole]], most prominent cardiac symptoms are due to conduction delays, since magnesium acts as physiologic [[Calcium channel blocker|calcium blocker]].
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| Clinical consequences related to serumconcentration:
| | ==[[Hypermagnesemia differential diagnosis|Differentiating Hypermagnesemia from other Diseases]]== |
| *4.0 mEq/l [[hyporeflexia]]
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| *>5.0 mEq/l Prolonged atrioventricular conduction
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| *>10.0 mEq/l Complete [[heart block]]
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| *>13.0 mEq/l [[Cardiac arrest]]
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| ==Causes== | | ==[[Hypermagnesemia natural history|Natural History, Complications and Prognosis]]== |
| Since magnesium is excreted through the [[kidney]]s, [[renal failure]] can result in hypermagnesemia. The most important cause however is suppletion.
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| ===Predisposing conditions=== | | ==Diagnosis== |
| *[[Hemolysis]], magnesium concentration in erythrocytes is approximately three times greater than in serum, therefore hemolysis can increase plasma magnesium. Hypermagnesemia is expected only in massive hemolysis.
| | [[Hypermagnesemia history and symptoms|History and Symptoms]] | [[Hypermagnesemia physical examination|Physical Examination]] | [[Hypermagnesemia laboratory tests|Laboratory Findings]] | [[Hypermagnesemia ultrasound|Ultrasound]] |
| *[[Renal insufficiency]], excretion of magnesium becomes impaired when [[creatinine clearance]] falls below 30 ml/min. However, hypermagnesemia is not a prominent feature of renal insufficiency unless magnesium intake is increased.
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| *Other conditions that can predispose to mild hypermagnesemia are [[diabetic ketoacidosis]], [[adrenal insufficiency]], [[hyperparathyroidism]] and [[lithium]] [[intoxication]].
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| ==Therapy== | | ==Treatment== |
| Prevention of hypermagnesemia usually is possible. In mild cases, withdrawing magnesium suppletion is often sufficient. In more severe cases the following treatments are used:
| | [[Hypermagnesemia medical therapy|Medical Therapy]] |
| * [[Intravenous]] [[calcium gluconate]], because the actions of [[magnesium]] in [[neuromuscular]] and [[cardiac]] function are antagonized by [[calcium]].
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| Definitive treatment of hypermagnesemia requires increasing renal magnesium excretion through:
| | ==Case Studies== |
| * Intravenous [[diuretic]]s, in the presence of normal [[renal function]]
| | [[Hypermagnesemia case study one|Case#1]] |
| * [[Dialysis]], when kidney function is impaired and the patient is symptomatic from hypermagnesemia
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| {{Endocrine, nutritional and metabolic pathology}} | | {{Endocrine, nutritional and metabolic pathology}} |
