HYPOMAGNESEMIA

HYPOMAGNESEMIA -it refers to the below normal serum magnesium concentration. The normal serum Mg is 1.5;2.5mEq/L It is most common yet often overlooked imbalance in acutely and critically ill patients. It may occur with withdrawal from alcohol and administration of tube feedings or parenteral nutrition.

GI tract- this is a impt route for Mg loss. Loss of Mg from the GI tract may be due to the NGT, diarrhea or fistulas.

CLINICAL MANIFESTATIONS
Muscle weakness Tremors Tetany + chvosteks and trousseaus sign

ECG

Prolonged QRS, depressed ST segment, causing cardiac dysrhythmias, such as premature ventricular contractions and torsades de pointes (a form of ventricular tachycardia).

ASSESSMENT AND DIAGNOSTIC FINDINGS

Lab analysis- serum Mg level is <1.5 mEq/L or 1.8 mEq/L. hypomagnesemia is associated with hypokalemia and hypocalcemia. ECG Urinary Mg levels- to identify the causes of Mg depletion, is also measured after a loading dose of Mg sulfate. Two newer diagnostic techniques ( nuclear magnetic resonance spectroscopy and the ion selective electrode ).

MEDICAL MANAGEMENT
Mild Mg deficiencies- can be corrected by diet alone Green leafy vegetables, nuts, legumes, whole grain, seafood, peanut butter and chocolate. Mg salts can be administered orally to replace continuous excessive losses. Pt. receiving parenteral nutrition require Mg in the IV solution to prevent hypomagnesemia. IV administration of Mg sulfate must be given by an infusion pump at the rate not exceeding 150 mg/min. NOTE: a dose of Mg SO4 given too rapidly can cause cardiac arrest.

V/S must be assessed frequently during Mg administration ( to detect changes in HR or rhythms, hypotension and respiratory distress). Urine output monitoring is essential before during and after Mg administration the physician is notified if urine volume decreases to less than 100 ml over 4 hrs.

NURSING MANAGEMENT
The nurse should be aware of pt at risk for hypomagnesemia and observe for its sign and symptoms. Pt receiving digitalis are monitored closely When hypomagnesemia is severe, seizure precautions are implemented. Bec.dysphagia may occur in Mg depleted pts the ability to swallow should be tested with H2O before oral meds or food are offered. To determine neuromuscular irritability, the nurse needs to assess and grade deep tendon reflex.

Teachings plays a major role in treating Mg deficit particularly that resulting from abuse of diuretics or laxatives. For pt experiencing hypomagnesemia from abuse of alcohol, the nurse can provide teaching assessing and support or possible referral to alcohol abstinence programs or other professional help.