From the Guidelines
Treatment for hypermagnesemia involves discontinuing magnesium intake, enhancing its elimination, and administering calcium gluconate to counteract its effects, as recommended by the American Heart Association guidelines 1. The primary goal is to reduce magnesium levels and alleviate symptoms.
- Discontinue any magnesium-containing medications, supplements, or antacids.
- Increase fluid intake and ensure normal kidney function to enhance magnesium excretion.
- For symptomatic patients, administer intravenous calcium gluconate (10 ml of 10% solution over 10 minutes) to temporarily counteract magnesium's effects on the nervous system and heart, as suggested by the 2010 American Heart Association guidelines 1.
- Loop diuretics like furosemide (20-40 mg IV) may increase magnesium excretion.
- In life-threatening situations or kidney failure, hemodialysis effectively removes magnesium from the bloodstream.
- Cardiac monitoring is essential during treatment, especially with severe hypermagnesemia, as high magnesium levels can cause dangerous heart rhythm abnormalities, including bradycardia, cardiac arrhythmias, and cardiorespiratory arrest 1.
- Magnesium levels should be regularly checked until they normalize.
- Addressing the underlying cause, such as kidney dysfunction, is crucial to prevent recurrence of hypermagnesemia.
From the Research
Treatment for Hypermagnesemia
The treatment for hypermagnesemia, a condition characterized by elevated magnesium levels, typically involves a combination of supportive therapies.
- Administration of high-volume fluids to help dilute the magnesium in the blood 2, 3
- Calcium preparation, such as calcium gluconate, to counteract the effects of excess magnesium on the body 2, 3
- Diuretics, like loop diuretics, to increase magnesium excretion in the urine 2, 3
- In severe cases, hemodialysis may be necessary to rapidly correct magnesium levels 2, 3, 4
Considerations for Patients with Normal Renal Function
In patients with normal renal function, severe hypermagnesemia can still occur, particularly in cases of constipation under MgO treatment 2.
- Symptomatic treatment without hemodialysis may be effective in improving hypermagnesemia in these patients 2
Importance of Monitoring and Adjusting Dialysate Magnesium Concentration
For patients on dialysis, monitoring and adjusting the dialysate magnesium concentration is crucial to maintain plasma magnesium concentration within the normal range 4, 5.
- Regular measurement of predialysis plasma magnesium is recommended to adjust the dialysate magnesium concentration accordingly 5