Hypermagnesemia

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Hypermagnesemia
Classification and external
resources

Magnesium
ICD-10 E83.4
ICD-9 275.2
DiseasesDB 6259
med/3383
eMedicine emerg/262
ped/1080

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 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 antacids and laxatives). It is usually
concurrent with hypercalcemia and/or hyperkalemia.

Contents
[hide]

• 1 Metabolism
• 2 Symptoms
• 3 Causes
o 3.1 Predisposing conditions

• 4 Therapy

[edit] Metabolism
For a detailed description of magnesium homeostasis and metabolism see hypomagnesemia.

[edit] Symptoms
 • Weakness, nausea and vomiting
• Impaired breathing
• Hypotension
• Hypocalcemia
• Arrhythmia and Asystole

Arrhythmia and asystole are possible cardiac complications of hypermagnesemia. Magnesium

acts as physiologic calcium blocker, which results in electrical conduction abnormalities.

Clinical consequences related to serum concentration:

• 4.0 mEq/l hyporeflexia

• >5.0 mEq/l Prolonged atrioventricular conduction
• >10.0 mEq/l Complete heart block
• >13.0 mEq/l Cardiac arrest

[edit] Causes
Since magnesium is excreted through the kidneys, renal failure (as a result of hypermagnesemia)
most often occurs due to prolonged over supplementation or long term use of magnesium
containing medications or laxatives.

[edit] Predisposing conditions

• 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.
• 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.
• Other conditions that can predispose to mild hypermagnesemia are diabetic ketoacidosis,
adrenal insufficiency, hyperparathyroidism and lithium intoxication.

[edit] Therapy
Prevention of hypermagnesemia usually is possible. In mild cases, withdrawing magnesium
suppletion is often sufficient. In more severe cases the following treatments are used:

• Intravenous calcium gluconate, because the actions of magnesium in neuromuscular and

cardiac function are antagonized by calcium.

Definitive treatment of hypermagnesemia requires increasing renal magnesium excretion

through:

• Intravenous diuretics, in the presence of normal renal function

• Dialysis, when kidney function is impaired and the patient is symptomatic from
hypermagnesemia