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词条 Hypermagnesemia
释义

  1. Signs and symptoms

  2. Causes

     Predisposing conditions  Metabolism 

  3. Diagnosis

  4. Treatment

  5. References

  6. External links

{{Infobox medical condition (new)
| name = Hypermagnesemia
| synonyms =
| image = Mg-TableImage.png
| caption = Magnesium
| pronounce =
| field = Endocrinology
| symptoms = Weakness, confusion, decreased breathing rate[1]
| complications = Cardiac arrest[1]
| onset =
| duration =
| types =
| causes = Kidney failure, treatment induced, tumor lysis syndrome, seizures, prolonged ischemia[3][1]
| risks =
| diagnosis = Blood level > 1.1 mmol/L (2.6 mg/dL)[1][6]
| differential =
| prevention =
| treatment = Calcium chloride, intravenous normal saline with furosemide, hemodialysis[1]
| medication =
| prognosis =
| frequency = Uncommon[6]
| deaths =
}}Hypermagnesemia is an electrolyte disorder in which there is a high level of magnesium in the blood.[1] Symptoms include weakness, confusion, decreased breathing rate, and decreased reflexes.[1][1] Complications may include low blood pressure and cardiac arrest.[12][1]

It is typically caused by kidney failure or is treatment induced such as from antacids that contain magnesium.[1][2] Less common causes include tumor lysis syndrome, seizures, and prolonged ischemia.[3] Diagnosis is based on a blood level greater than 1.1 mmol/L (2.6 mg/dL).[1][1] It is severe if levels are greater than 2.9 mmol/L (7 mg/dL).[3] Specific electrocardiogram (ECG) changes may be present.[1]

Treatment involves stopping the magnesium a person is getting.[3] Treatment when levels are very high include calcium chloride, intravenous normal saline with furosemide, and hemodialysis.[4] Hypermagnesemia is uncommon.[1] Rates may be as high as 10% among those in hospital.[5]

Signs and symptoms

{{refimprove|date=March 2014}}
  • Weakness, nausea and vomiting
  • Impaired breathing
  • Decreased respirations
  • Low blood pressure
  • Low blood calcium
  • Abnormal heart rhythms and asystole
  • Decreased or absent deep tendon reflexes
  • Low heart rate
  • Dizziness
  • Sleepiness

Abnormal heart rhythms and asystole are possible complications of hypermagnesemia related to the heart. Magnesium acts as a physiologic calcium blocker, which results in electrical conduction abnormalities within the heart.

Clinical consequences related to serum concentration:

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

Note that the therapeutic range for the prevention of the pre-eclampsic uterine contractions is: 4.0-7.0 mEq/L.[6] As per Lu and Nightingale,[7] serum Mg2+ concentrations associated with maternal toxicity (also neonate depression - hypotonia and low Apgar scores) are:

  • 7.0-10.0 mEq/L - loss of patellar reflex
  • 10.0-13.0 mEq/L - respiratory depression
  • 15.0-25.0 mEq/L - altered atrioventricular conduction and (further) complete heart block
  • >25.0 mEq/L - cardiac arrest

Causes

Magnesium status depends on three organs: uptake in the intestine, storage in the bone and excretion in the kidneys. Hypermagnesemia is therefore often due to problems in these organs, mostly intestine or kidney.[8]

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.
  • Kidney 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, hypothyroidism, hyperparathyroidism and lithium intoxication.

Metabolism

For a detailed description of magnesium homeostasis and metabolism see hypomagnesemia.

Diagnosis

Hypermagnesemia is diagnosed by measuring the concentration of magnesium in the blood. Concentrations of magnesium greater than 1.1 mmol/L are considered diagnostic.[4]

Treatment

Prevention of hypermagnesemia usually is possible. In mild cases, withdrawing magnesium supplementation 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 kidney function
  • Dialysis, when kidney function is impaired and the patient is symptomatic from hypermagnesemia

References

1. ^1 2 3 4 5 {{cite web |title=Hypermagnesemia |url=https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypermagnesemia |website=Merck Manuals Professional Edition |accessdate=28 October 2018}}
2. ^{{cite book| first1=Andrea, M.P.| last1=Romani|editor=Astrid Sigel|editor2=Helmut Sigel|editor3=Roland K. O. Sigel|title=Interrelations between Essential Metal Ions and Human Diseases|series=Metal Ions in Life Sciences|volume=13|year=2013|publisher=Springer|pages=49–79|chapter=Chapter 3. Magnesium in Health and Disease|doi=10.1007/978-94-007-7500-8_3}}
3. ^1 {{cite book |last1=Lerma |first1=Edgar V. |last2=Nissenson |first2=Allen R. |title=Nephrology Secrets |date=2011 |publisher=Elsevier Health Sciences |isbn=0323081274 |page=568 |url=https://books.google.ca/books?id=d6LlS7XBS2YC&pg=PA568 |language=en}}
4. ^1 2 3 4 5 6 7 8 9 10 11 {{cite journal|last1=Soar|first1=J|last2=Perkins|first2=GD|last3=Abbas|first3=G|last4=Alfonzo|first4=A|last5=Barelli|first5=A|last6=Bierens|first6=JJ|last7=Brugger|first7=H|last8=Deakin|first8=CD|last9=Dunning|first9=J|last10=Georgiou|first10=M|last11=Handley|first11=AJ|last12=Lockey|first12=DJ|last13=Paal|first13=P|last14=Sandroni|first14=C|last15=Thies|first15=KC|last16=Zideman|first16=DA|last17=Nolan|first17=JP|title=European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.|journal=Resuscitation|date=October 2010|volume=81|issue=10|pages=1400–33|pmid=20956045|doi=10.1016/j.resuscitation.2010.08.015}}
5. ^1 2 3 {{cite book |last1=Ronco |first1=Claudio |last2=Bellomo |first2=Rinaldo |last3=Kellum |first3=John A. |last4=Ricci |first4=Zaccaria |title=Critical Care Nephrology |date=2017 |publisher=Elsevier Health Sciences |isbn=9780323511995 |page=344 |url=https://books.google.ca/books?id=HTdDDwAAQBAJ&pg=PA344 |language=en}}
6. ^{{cite journal | author = Pritchard JA | year = 1955 | title = The use of the magnesium ion in the management of eclamptogenic toxemias | url = | journal = Surg Gynecol Obstet | volume = 100 | issue = | pages = 131–140 }}
7. ^{{cite journal | author = Lu JF, Nightingale CH | year = 2000 | title = Magnesium sulfate in eclampsia and pre-eclampsia | url = | journal = Clin Pharmacokinet | volume = 38 | issue = | pages = 305–314 | doi=10.2165/00003088-200038040-00002 | pmid=10803454}}
8. ^{{cite journal |vauthors=Jahnen-Dechent W, Ketteler M |title= Magnesium basics |journal= Clin Kidney J |volume=5 |issue= Suppl 1 |pages= i3–i14 |year=2012 |doi=10.1093/ndtplus/sfr163|url= http://ckj.oxfordjournals.org/content/5/Suppl_1/i3.full.pdf}}

External links

{{Medical resources
| DiseasesDB = 6259
| ICD10 = {{ICD10|E|83|4|e|70}}
| ICD9 = {{ICD9|275.2}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = med
| eMedicineTopic = 3383
| eMedicine_mult = {{eMedicine2|emerg|262}} {{eMedicine2|ped|1080}}
| MeshID =
}}{{Mineral metabolic pathology}}

5 : Electrolyte disturbances|Magnesium|Nephrology|Toxic effects of metals|RTT
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