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  • • Renal insufficiency

    • Elevated serum magnesium

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Epidemiology

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  • • Usually occurs in patients with renal disease

    • Rare in surgical patients

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Symptoms and Signs

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  • • Lethargy

    • Weakness

    • Widened QRS complex

    • Depressed ST segment

    • Peaked T waves

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  • • When serum level reaches 6 mEq/L, deep tendon reflexes are lost

    • Levels > 10 mEq/L can lead to somnolence, coma, and death

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  • • Magnesium should be carefully monitored in patients with renal insufficiency

    • Serum levels

    • ECG

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  • • IV isotonic saline to increase renal excretion

    • Slow IV infusion of calcium

    • Dialysis may be necessary

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Medications

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  • • Isotonic saline infusion

    • Calcium gluconate infusion

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Treatment Monitoring

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  • • ECG monitoring

    • Serum magnesium levels

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Prognosis

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  • • Excellent if treated

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Prevention

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  • • Regulation of magnesium intake in patients with renal insufficiency

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References

Whang R. Clinical disorders of magnesium metabolism. Compr Ther. 1997;23:168.  [PubMed: 9113454]
Onishi S. Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Internal Medicine. 2006, 45(4):207-10.  [PubMed: 16543690]

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