Bicol University

COLLEGE OF NURSING
Legazpi City

Mark Zedrix A. Mediario

BSN 3C

Related Learning Activity (Magnesium Deficit)

A 56-year-old female patient was evaluated at the Emergency Department (ED) for recurrent symptoms
of palpitations. Laboratory evaluation revealed normal serum electrolytes, renal function, complete blood
count, thyroid stimulating hormone level, ionized calcium and serial cardiac enzymes, including creatine
kinase (CK-MB) and troponin-I levels. However, the patient was found to have a decreased serum
magnesium level, ranging from 1.3 to 1.5 mg/dL (normal 1.7-2.7 mg/ dL).

The patient revealed that she had experienced occasional symptoms of shortness of breath with activity,
but no symptoms of dyspnea at rest, orthopnea or paroxysmal nocturnal dyspnea. The palpitations usually
resolved spontaneously within 5 minutes.

The patient’s cardiac risk factors included a history of hypertension, type 2 diabetes, hypercholesterolemia
and a family history of cardiac disease.

On physical examination, the blood pressure was 128/72, the heart rate was 70 and the respiratory rate
was 16. The lungs were clear to auscultation. On cardiac examination, there was a regular rhythm with a
soft systolic murmur at the left sternal border. There was no abdominal bruit present. On extremity
examination, peripheral pulses were present and there was no edema.

The metabolic evaluation was normal except for a mildly decreased vitamin D level. The renal evaluation,
including urinary electrolyte and magnesium excretion, indicated that the hypomagnesemia was most
likely a result of diabetic nephropathy, possibly exacerbated by the Vitamin D deficiency.

1. How do you equate hypomagnesemia with low vitamin D level?

Magnesium helps regulate levels of vitamin D. It raises levels of vitamin D in people who
need more of that substance and lowers levels among those who have an excess amount of the
vitamin in their system. Hence, serum magnesium levels affect the concentration of circulating
vitamin D in the blood. Lower levels of serum magnesium are associated with hypovitaminosis D.
Hypomagnesemia lowers the concentration of vitamin D in the body.
 Bicol University
COLLEGE OF NURSING
Legazpi City

2. How do you relate magnesium deficit to renal disorder?

The kidney plays a major role in regulating the balance of magnesium. A well-functioning
kidney is significant for proper magnesium homeostasis. Moreover, a decline in kidney function
might significantly influence magnesium homeostasis. In cases of a renal disorder, such as chronic
kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg
absorption, which can lead to magnesium deficiency.

3. Identify the signs and symptoms of magnesium deficit?

Hypomagnesemia or magnesium deficit has the following signs and symptoms:

Neuromuscular changes:
Muscle weakness with hyperactive deep tendon reflexes, tremor, leg and foot cramps, slow
involuntary writhing and twisting, paresthesia, convulsions
Positive Trousseau’s sign
Positive Chvostek’s sign
CNS changes:
Agitation
Depression
Personality changes
Confusion
Auditory and visual hallucinations
Cardiovascular abnormalities:
Arrhythmias
ECG abnormalities: P-R and Q-T intervals are prolonged, QRS complex widens, T wave
becomes flat or inverted, S-T segment is depressed

4. Using the above scenario, formulate a nursing care plan for a client with hypomagnesemia.
NURSING CARE PLAN
Cues Nursing Background Goals Nursing Rationale Evaluation
Diagnosis Knowledge Intervention
Subjective Electrolyte An electrolyte Long Term Short Term Independent After the nursing
• Recurrent imbalance related imbalance After the After three 8-hour shifts of • Obtain and • For frequent interventions, the goals
palpitations that to diabetic happens when nursing nursing interventions, the monitor vital monitoring of were met as evidenced
resolve within 5 nephropathy as electrolyte levels interventions, client will be able to: signs and client’s overall by:
minutes evidenced by in the blood are the client will a. reestablish a laboratory status and a. normal
• Occasional hypomagnesemia too high or too be able to normal test values like detecting electrolyte
dyspnea on and vitamin D low. maintain a electrolyte magnesium abnormalities balance, with
exertion deficiency Hypomagnesemia normal balance, with and vitamin D normal
• History of type 2 is an electrolyte electrolyte normal levels magnesium and
diabetes disturbance caused balance, with magnesium and • Monitor for • For detecting vitamin D levels,
when there is a normal vitamin D levels, changes in ECG b. absence of signs
Objective low level of serum magnesium b. be free of ECG abnormalities of complications
• Hypomagnesemia magnesium (less and vitamin D complications which are associated with
due to diabetic than 1.7 mg/dL) in levels. associated with possible due to hypomagnesemia
nephropathy the blood. hypomagnesemia hypomagnesemia and vitamin D
• Mild vitamin D Diabetic persons and vitamin D • Keep accurate • Helps evaluate deficiency,
deficiency usually have low deficiency, and fluid intake fluid and c. and verbalization
magnesium levels, c. verbalize and output electrolyte of understanding
especially if their understanding records balance and willingness
blood sugar is and willingness • Formulate a • Provides an oral to comply to the
uncontrolled, as to comply to the dietary plan replacement for dietary plan for
the kidney dietary plan for for daily mild magnesium daily
attempts to clear daily recommended deficits; may recommended
out the sugar recommended intake of prevent a intake of
along with the intake of magnesium- recurrence magnesium-rich
magnesium. The magnesium-rich rich foods and foods.
kidney plays a foods. encourage the
major role in client to
regulating the comply to the
dietary plan
balance of • Educate the • To help the
magnesium. client and client and family
Moreover, a family about understand the
decline in kidney the disease client’s condition
function process of
might significantly diabetes and
influence how it affects
magnesium the electrolyte
homeostasis. In balance of the
cases of a renal body
disorder, such as • If untoward • For immediate
diabetic signs appear, response to the
nephropathy, notify the client and
regulatory physician prevent further
mechanisms may immediately complications
be insufficient to Dependent
balance intestinal • Administer • Preferred in
Mg magnesium severe deficit in
absorption, which replacement treating for
can lead to therapy as hypomagnesemia
magnesium ordered
deficiency. Interdependent
Magnesium helps • Refer to a • To provide a
regulate levels of dietician for more reliable and
vitamin D, hence, tailoring an effective diet
with low levels of individual plan for the
magnesium, it can eating plan client
lead to vitamin D according to
deficiency. client’s needs,
as necessary